Errors in spinal surgery

Spinal surgery can be carried out by both orthopaedic and neurosurgeons, although neurosurgery focuses on the central nervous system and orthopaedic surgery tends to focus on the bone.

Spinal surgery can be carried out for a number of reasons, for example to relieve compression on the spinal cord, stabilise the unstable or remove tumours.

Negligence can occur for a number of reasons:

• Failure to image properly (x-ray/CT/MRI)
• Failure to read imaging properly
• Failure to operate in time
• Excessive surgery
• Wrong level surgery
• Wrong side surgery
• Inadequate surgery
• Misplaced screws
• Failure to correctly consent patients

From time to time, spinal surgeons will operate at the wrong level of the spine, and therefore on incorrect discs or vertebrae. Such errors will often lead to further surgery being required once the mistake has been realised. To look at the spine, surgeons use x-rays, CT scans and MRIs. X-rays are readily available but it is easy to miss things.

CT scans are more detailed than x-rays but can sometimes be obstructed. MRI scans are the gold standard but are not as readily available and require careful interpretation. There are around 7 to 12 spinal surgeons at the nearest Major Trauma Centre (St George’s Hospital).

If patients attend GPs, pain consultants, physiotherapists or chiropractors or even district general hospitals where there are fewer spinal surgeons, patients are reliant on timely referrals, on the correct pathways being applied and then a competent review of imaging by a competent surgeon. Do not be afraid to ask your surgeon about his or her training, practice focus, experience with whatever operation has been recommended, and whether you the patient have been presented all of the options that exist.

What is determined as a spinal injury?

Spinal injuries include fracture of the spinal cord (complete and partial) and pressure on the spinal cord causing total or partial loss of blood supply.

It first helps to provide a very basic anatomy lesson of the spine.

The spinal column exists from the base of the skull to the pelvis. It consists of 33 vertebrae (interlocking bones) which are separated by discs. The spinal column houses and protects the spinal cord – the long tubular bundle of nervous tissue. The spinal cord itself is divided into five regions:

24 articulating (moving) vertebrae:

• Cervical spine: C1–C7
• Thoracic spine: T1–T12
• Lumbar spine: L1–L5

9 fused vertebrae (five in the sacrum and four in the coccyx or tailbone):

• Sacrum: S1–S5
• Thoracic spine

Different severities of a spinal cord injury

The extent of spinal cord injury is defined by the American Spinal Injury Association (ASIA) Impairment Scale (modified from the Frankel classification), using the following categories:

1. No sensory or motor function is preserved in sacral segments S4-S5
2. Sensory, but not motor, function is preserved below the neurologic level and extends through sacral segments S4-S5
3. Motor function is preserved below the neurologic level, and most key muscles below the neurologic level have a muscle grade of less than 3
4. Motor function is preserved below the neurologic level, and most key muscles below the neurologic level have a muscle grade that is greater than or equal to 3
5. Normal: Sensory and motor functions are normal

These serious orthopaedic injuries often involve catastrophic and permanent disability and leave the injured person with a vast array of physical and psychiatric needs, including carers, case managers, rehabilitation, further medical treatment, house adaptations to single story living and medical equipment. Very often, these injuries leave people unable to work which makes funding all of these things impossible.