Can spinal surgery go wrong?

Patients suffering from failed back surgery report symptoms of:

• new pain at a level different from the location treated;
• inability to recuperate;
• restricted mobility;
• sharp, stabbing back pain;
• numbness or pain radiating through the lower back into the legs;
• back spasms.

Red flag symptoms include:

• saddle anaesthesia or bowel incontinence, indicative of cauda equina syndrome;
• fever, chills or weight loss indicating infection;
• signs of malignancy (i.e. signs of cancerous cells in the region).

When any of these symptoms are present, urgent medical assistance should be sought.

Back surgery carries significant risks of operative and post-operative neurological complications, and neurological structures may be damaged directly or indirectly.

Damage can occur as a result of contact with the surgical equipment, anaesthetic equipment, the implant components, a haematoma, tearing of the structures, and others.

It is worth noting that neurological complications don’t always occur in the treated area due to the complexities of the neurological system.

The neurological risks can involve:

• ocular complications;
• brachial plexus complications;
• truncal involvement which may involve all limbs;
• cervical spine injury including the risks of myelopathy, medullary atrophy or ossification of the posterior longitudinal ligament;
• thoracic and lumbar spine injury including the risk of complete or partial paraplegia, medullary or radicular complications;
• neurological risk arising from spinal implants;
• post-operative complications such as epidural hematoma and dural tear.

Cerebrospinal fluid (CSF) is a clear liquid that surrounds the brain and spine. It prevents damage and helps with circulation of nutrients and impurities.

CSF leakage may occur spontaneously, after trauma or after surgery. Spinal surgery is one of the primary contributing factors to a CSF leak, though.

If discovered during surgery, the CSF leak will be patched and repaired. In some circumstances the leak may occur after surgery and further surgery may be required to repair this.

Spinal CSF leaks are a serious medical emergency and treatment should be sought immediately.

If mismanaged, CSF leaks can lead to serious consequences such as CSF fistulas, meningitis, brain abscess, intercranial haemorrhage, haematoma and neurological deficits. Some of these complications are life-threatening.

Spinal CSF leak patients report the following symptoms:

• headaches usually presenting with pain in the back of the head;
• headaches that improve when lying down;
• headaches that worsen when standing up;
• headaches that may start or worsen when coughing or straining;
• “thunderclap” headaches that start suddenly.

Spinal fusion is a surgical procedure which links two vertebrae into one modular unit. This prevents movement and involvement of nerves and tissue and can alleviate pain.

In order to connect vertebrae a bone graft is used. The bone graft can be from the patient themselves, it can come from a donor, or it may be artificially created.

Pseudarthrosis (failed fusion) is a significant recognised complication of spinal fusion, and it can be both symptomatic and asymptomatic. Donor graft rejection is one of the primary causes of pseudoarthrosis. Whilst the bone graft used is dead and does not have to have cells or proteins to stimulate growth, rejection of the implant does sometimes occur.

Metal hypersensitivity and titanium hypersensitivity are extremely rare complications which can also result in a body rejecting the implant.

Spinal fusion carries significant risk of complications later in life.

The risks of spinal fusion include, but are not limited to:

• hardware failure;
• stress and degeneration to adjacent spinal segments;
• injury to adjacent spinal segments;
• chronic back pain;
• reduced mobility;
• nerve damage;
• pseudoarthrosis.

Spinal fusion effectiveness greatly varies from person to person. There are a multitude of contributing factors including the severity of pre-operative spinal problems, patient age, obesity and degree of calcification.

Whilst spinal fusion is meant to last for life, some patients require further treatment only a few years after surgery.

Spinal stenosis is the narrowing and reduction of space for the spinal nerves leading to irritation. This usually occurs as a result of aging but can be the result of conditions such as osteoarthritis, certain bone diseases, rheumatoid arthritis injury to the spine and narrow spinal canal. It can also be caused by negligent spinal surgery.

Lumbar spinal stenosis is permanent and usually does not require treatment but it’s symptoms should be managed.

In other cases, depending on the degree of stenosis, patients may require surgery to remove tissue in order to alleviate the irritation. With certain bone diseases where stenosis is more aggressive, re-operation is required several years after the original procedure.

In some rare cases, lumbar spinal stenosis can cause cauda equine syndrome which is a medical emergency and requires immediate care.

Back surgery failure is associated with multiple factors including patient, surgical and post-surgical factors.

Patient-related factors include obesity, smoking, age, psychological wellbeing and previous back surgeries.

Surgical and post-surgical factors include taking an incorrect surgical approach, issues with equipment or implant components, haematomas, collection of fluid near the spine, infections, and nerve injury.

Information relating to the success of L4, L5 surgery is conflicting with some studies reporting a success rate of around 70% to 90% whilst others report a success rate of around 60% to 80%.

Cauda equina syndrome (CES) is a medical emergency and requires immediate treatment. It is most commonly caused by compression of the lumbosacral nerve roots.

The most common problems arising from cauda equina surgery are bladder function problems, motor function problems, sensation problems and problems with leg pain, lower back pain and general neurology.

Owing to the complexity of back surgery, the elevated risks of patients with pre-existing back problems, and the difficulty in completely eliminating back pain, the risk of pain post-operatively is even higher than most other types of surgery.

The most common causes of continued pain are epidural fibrosis, recurrent stenosis after decompression, failure of fusion or post-fusion adjacent segment disease.

Chronic pain after spine surgery (CPSS) is usually described as low back pain and/or radiating leg pain which is not improving after three months from surgery.

This is often referred to as failed back surgery syndrome, which you can find out more about here.

The causes of chronic pain after spinal surgery are still largely unknown.

Spinal surgery carries significant risk of nerve damage which can be sustained both directly and indirectly by the surgery. The most common reported symptoms of post-operative nerve damage are feeling of pins and needles in the limbs, weakness of limbs, foot drop and neuropathic pain.

Nerve damage is usually not permanent and in most cases it recovers within a period of one year. In some cases where nerve damage doesn’t improve over a year it can become permanent.

It is sometimes difficult to know what to do if you suspect that your spinal surgery has gone wrong.

In some circumstances where medical professionals have reason to think there was an issue with the surgery, they will initiate an internal investigation resulting in a Serious Incident Report or a Root Cause Analysis. If this did not happen in your case, you can approach the treatment providers and lodge a formal complaint. It is unlikely that this will result in any financial compensation.

Should you wish to receive financial compensation, you need to lodge a claim for medical negligence. When taking this step, it is important to establish that your firm of solicitors have the necessary expertise in medical negligence and the particular field of treatment received, in this case claiming for negligent spinal surgery. It is also important to initiate the claim within the three-year statute of limitations period.

Claims for clinical negligence can be lodged against the NHS as well as against medical professionals operating outside of the NHS.

In order to have a successful claim the Claimant will have to satisfy the legal tests of breach of duty and causation.

Medical professionals owe a duty of care to their patients and they are held accountable to the standard of “a responsible body of medical opinion” meaning that if they acted below what is reasonably expected of a medical professional of their qualifications and expertise, their actions may represent a breach of duty.

Causation refers to any injury or loss suffered as a result of negligence. Causation is often the most difficult element of clinical negligence claims as we have to demonstrate that the injury/loss can be attributed to the negligence.

Claims in Clinical Negligence can be brought under Conditional Fee Agreements (often referred to as ‘no win, no fee’). If you think you may have a claim after your spinal surgery, you should contact a specialist clinical negligence solicitor.

Whilst there can be valid reasons for a surgical procedure to be cancelled, a breach of duty can arise from the failure or omission to provide treatment where necessary.

Should you consider that you suffered pain, injury or loss of amenity arising from cancelled surgery you can contact us for an assessment of your circumstances, and we can advise you further.

The Limitation Act sets out that you have three years from the date or the negligent act, or three years from the date you first became aware of the negligence – this is also known as the date of knowledge. However, there are some circumstances in which an exception can be made.

It is important to note that medical negligence claims take a long time to resolve and therefore, we advise that you seek legal advice as soon as you find out that you may have a potential claim.

This differs from each case depending on the facts, complexities and whether the NHS Trust admits liability before the case is issued at court. However, on average, a spinal claim can take around two to five years.

Claims can range from modest sums in the tens of thousands of pounds, to multimillion pound settlements.

Often the difference between the two is whether the negligence has resulted in a long-term adverse outcome which would have been avoided had the negligence not occurred. The larger claims include damages for pain, suffering, loss of amenity and past losses and expenses, but also cover any future needs that you may have. This could include adapted accommodation, care and assistance, tech, aids and equipment.

Find out more about medical negligence claims, including compensation amounts, time limits and more in our comprehensive guide to making a claim for medical negligence here.