The spine and medical negligence by R. W. Porter

By R. W. Porter

Greater than 20,000 spinal operations are performed within the united kingdom every year, and it really is inevitable and unlucky that error will sometimes be made. simply cautious realization to element within the pre-operative review, meticulous surgical care and supervised post-operative administration will ascertain constantly solid results.

This booklet illustrates the adaptation among the occasional inevitable hardship which could take place in specialist arms and avoidable error.

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It is the consultant who is responsible for the patient’s management, and this means that the consultant should also discuss the option of surgery with the patient. There can be exceptions if one considers the seniority of the traineeand the type and the urgency of surgery. There are only a few absolute indications forspine surgery - tumour, trauma, infection and a massive lesion in the spinal canal involving the bladder. Surgery for most other back pain problems is relative. It is a balance of risks and benefits.

T h i s avoids pressure in theaxilla and in the upper arm. In the lower limb the femoral nerve, peroneal nerve and the lateral femoral cutaneous nerve are at risk. These nerves are vulnerable to direct pressure because of their proximity to bone or to traction when they are stretched across a highly mobile joint. It is the surgeon's responsibility to check that these respective sites are free of pressure or tension. A 60-year-old obeselady had a discectomy at L5/S1. When she recovered from the anaesthetic she noticed that she had a new pain in thefront of the right thigh.

If the contusion is towards the midline, then the sacral roots are at risk, whilst if the contusion is lateral, one of the exiting lumbar roots is more likely to be involved. The surgeon will be aware of possible damage to the mid-line sacral roots because there will be a leakage of cerebro-spinal fluid. The mid-line sacral roots are intradural in the lumbar spine and in order to contuse an intradural root, the dura is usually torn. At the lateral side of the canal, the nerve roots are partly extradural, and contusion canoccur without a leak of cerebro-spinal fluid.

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