The spinal cord is a delicate part of the body and can be damaged very easily. Because of this, neurosurgeons go through rigorous training, even beyond medical school, in order to have the skills necessary to practice neurology.
These highly trained specialists are performing incredibly intricate procedures on patients, which unfortunately means they have a high probability of injuring a patient during a procedure or surgery.
In the United States, neurologists do, in fact, face the highest number of medical malpractice claims, above any other specialty, accounting for 19.1 percent of total claims.
While many of these claims are due to the sensitive nature of the specialty, if a physician has faced numerous claims, it may warrant further examination. The tension lies in the space between a neurosurgeon making a mistake during a difficult procedure and one who is practicing negligent medicine.
Neurosurgery is the medical specialty concerned with the diagnosis and treatment of diseases and disorders of the brain, spinal cord and spinal column, and peripheral nerves.
Additionally, a neurosurgeon provides both the operative and non-operative treatment a patient may need. They are specifically responsible for providing critical care, prevention, diagnosis, evaluation, treatment, and rehabilitation of disorders of the central, peripheral, and autonomic nervous systems.
As such, neurological surgery encompasses treatment of adult and pediatric patients with disorders of the nervous system; disorders of the brain, meninges, skull, and their blood supply, including the extracranial carotid and vertebral arteries; disorders of the pituitary gland; disorders of the spinal cord, and vertebral column, including those which may require treatment by spinal fusion or instrumentation; and disorders of the cranial and spinal nerves throughout their distribution.
What Does it Take to Become a Neurosurgeon?
The education needed to become a neurosurgeon is rigorous and extensive, requiring no less than four years of undergraduate studies, four years of medical school, and five to seven years of fellowship training.
After receiving a state medical license, neurosurgeons must practice for several years before they are eligible to obtain board certification through the American Board of Neurological Surgery (ABNS).
Common Surgical Spinal Injuries
Complications during a spinal surgery can cause subsequent pain and possibly the need for additional surgery.
Some of these complications can be expected with any surgery, including reactions to general anesthesia, including lung dysfunction, blood clots of the legs called Deep Vein Thrombosis (DVT); and infection.
Other complications are specific to neurosurgery.
Metal screws, plates, and rods, are used to hold the vertebrae in alignment while a surgery heals. These metal devices are called “hardware”.
It is possible for the hardware to either break or move from the correct position. This is called a “hardware fracture”. If this occurs it may require a second surgery to either remove or replace the hardware.
Implant migration is a term used when an implant has moved from where the surgeon initially placed it. This usually occurs fairly soon after surgery―before the healing process has firmly attached the implant to scar tissue or bone growth.
If the implant moves too far, it may no longer be stabilizing the vertebrae as intended. If it moves in a direction towards the spine or large vessels, it may damage those structures causing further damage.
Spinal Cord Injury
Any time a physician is operating on the spine, there is an associated risk to the spinal cord. This can lead to serious injuries to nerves or the covering of the spinal cord, called the dura. Most of the time, pain is caused by scar tissue that has formed in the area around the incision and surgical site.
Some spinal operations are simply unsuccessful and do not eradicate pain being experienced by a patient. In some cases, pain is unfortunately worsened by a procedure. Scar tissue can form near the nerve root, called epidural fibrosis, and is very common after spinal surgeries.
The spinal cord and spinal nerves carry the nerve signals that allow the rest of the body to function and feel sensation. Damage to the spinal cord or nerves surrounding the spinal cord can lead to sexual dysfunction.
When the entire spine is healthy, each segment works with its neighboring segment to share the stress imposed by movements and forces acting on the spine.
However, when one or two segments are not working properly, whether due to the injury or a repair, the neighboring segments have to take on more of the load. It is the segment closest to the non-working segment that absorbs most of the extra stress.
Over time, this can lead to increased wear and tear to this segment, eventually causing pain.
This is called transitional syndrome—or Bertolotti syndrome—because it occurs where the normal and abnormal sections of the spine are fused together after injury.
Pseudoarthrosis is a term used to describe either a fractured bone that has not healed or an attempted fusion that was not successful. A pseudoarthrosis usually means that there is motion between the two bones that should not be occurring.
When the vertebrae involved in a surgical fusion do not heal and fuse together properly, there is usually continued pain that may increase over time.
The spinal motion can also add stress to the metal hardware used to hold the fusion. The screws and rods may break, which can also lead to an increase in pain.
Duty of A Neurosurgeon
Though there are many complications that can occur during and after spinal surgery, a negligent or chronically negligent physician can make complications much worse—or even deadly.
Neurosurgeons may be found negligent either by misdiagnosing or wrongly diagnosing a spinal injury, improperly implanting hardware, prescribing the incorrect medications or dosages, or even by performing unnecessary spinal surgery.
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