Lower back surgery (lumbar surgery) is a last resort for many people who need pain relief, after other non-surgical options don’t work. Lower back pain can develop suddenly after a trauma or can be age-related and develop over time.
Consent forms and back surgery
In virtually every Texas medical malpractice case I’ve handled involving back surgery, one of the issues raised by the defendants is the consent paperwork. I’m writing this today from Detroit, Michigan, where I just finished presenting an orthopedic spine surgery expert for deposition—and today was no different. The defense attorney went over the hospital consent forms and made the point that my client, the patient, was aware of the risks of surgery, including nerve injuries, but decided to proceed anyway.
Looking at consent forms from a different angle, many of my clients have shared questions from well-intentioned friends and family—things like, “How can you sue the surgeon if you signed a consent form?” The answer to such questions is easy and straight-forward.
Consent forms obtain permission from patients to go forward with surgery, despite awareness of complications that might occur even with surgical, medical, and nursing care that is appropriate and meets the standard of care. On the other hand, no consent form gives the health care providers permission to provide a patient with negligent, sub-standard care.
How does post-surgical bleeding cause spinal cord or nerve damage?
One of the risks of spinal surgery is an epidural hematoma (an accumulation of bleeding) that places pressure on the spinal cord or nerve roots. It’s critical that surgeons, doctors, and nursing staff look for the early signs and symptoms of an epidural hematoma because it may require an emergency return to surgery to evacuate the hematoma and decompress the pressure on the spinal cord or nerve roots.
The spinal cord is a bundle of nerves that ends near L1 or L2 (the 1st and 2nd lumbar vertebra), depending on the anatomical variations of the person. After the spinal cord ends, nerve roots continue to sprout downward in what’s called the cauda equina, which means “horse’s tail.”
When a hematoma causes unrelieved compression of the spinal cord, it can cause spinal cord compression and permanent injury. At the levels of the cauda equina, unrelieved nerve root compression causes cauda equina syndrome.
Special lumbar surgery risks you should know about
Many patients who have lower back surgery have it done at multiple levels. For example, an orthopedic spine surgeon may perform a spinal fusion surgery at the levels of L3-L4 and L4-L5 (meaning the 3rd to 5th lumbar vertebrae). Patients who have spinal surgery at multiple levels have a higher risk for epidural hematoma formation and cauda equina syndrome.
Another factor that increases risk to lumbar surgery patients is an incidental durotomy, which is when the surgeon accidentally nicks or punctures the dura (outer protective covering) of the spinal cord or cauda equina. Injuring the dura mater is usually not negligent by itself. The question is whether the surgeon recognized the complication and repaired it properly.
When it comes to lumbar surgery, though, a durotomy should raise the surgeon’s diligence in watching for post-surgical complications. An incidental durotomy raises the risk of epidural hematoma by releasing spinal fluid pressure that impacts spinal blood vessels. This allows them to become engorged with blood and, in turn, can lead to more bleeding at the site of the surgery.
Finally, another risk factor is when a surgeon decides against placing a deep wound drain. Surgeons typically use deep wound drains to prevent too much blood from accumulating. When blood accumulation happens, it can lead to an epidural hematoma that compresses the lumbar spinal cord or nerve roots.
What are the signs of lumbar cord or nerve root compression?
Surgeons and nursing staff need to be on the lookout for symptoms including urinary retention (inability to urinate), bowel or bladder dysfunction, lower extremity motor weakness (inability to move normally), numbness from the waist down, and a new increase in pain.
While any of these signs don’t immediately mean that there’s an epidural hematoma or compression, if a patient has even one of them, the standard of care requires nurses to notify the surgeon immediately. The surgeon, in turn, is required to evaluate (or have the nurse examine) the patient for groin/saddle area feeling. This can often be as simple as asking the patient if there’s any feeling when a catheter is inserted.
If there’s this additional abnormality on examination, the next step is a physician order for a stat (immediate/emergency) MRI. If the MRI shows compression, then the patient needs to go back to the operating room immediately for surgery to remove the hematoma and relieve compression.
The good news is that patients tend to recover quickly if the surgeon and nurses are attentive. The bad news is, if they’re not, injuries can be permanent. In lumbar procedures, the impairments can be harsh, including total loss of bowel and bladder control, numbness from the waist down, and motor weakness in the lower extremities. This can make normal life difficult and miserable.
We are here to help
If you or a loved one has been seriously injured by hospital or physician care, then the experienced medical malpractice attorneys at Painter Law Firm, in Houston, Texas, are here to help. Click here to send us a confidential email via our “Contact Us” form or call us at 281-580-8800.
All consultations are free and, because we only represent clients on a contingency fee, you will owe us nothing unless we win your case. We handle cases in the Houston area and all over Texas. We are currently working on medical malpractice lawsuits in Houston, The Woodlands, Sugar Land, Conroe, Dallas, Austin, San Antonio, Corpus Christi, Bryan/College Station, and Waco.
Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. A member of the board of directors of the Houston Bar Association, he was honored, in 2018, by H Texas as one of Houston’s top lawyers. In May 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.