Bolt Burdon Kemp: Should spinal cord monitoring be used for Scoliosis operative procedures?

Scoliosis is a condition which causes the spine to curve. Most commonly, it occurs in adolescents as they go through puberty. If the curvature is progressive, it may require a surgical procedure to correct it.  Spinal scoliosis surgery is complex and can be life altering. The procedure typically involves straightening the spine then securing it with metal work to prevent further curvatures. 

As this operation involves straightening the spine, and as the spine encompasses the spinal cord, the procedure is not without risk. A known, but rare, complication is that of paralysis during or immediately following surgery. 

The procedures used to monitor patients during scoliosis surgery have advanced so that this resultant paralysis can be avoided or at least minimised.

At Bolt Burdon Kemp we know that if paralysis does develop following the surgery, and the symptoms are identified immediately, there are steps which can be taken either to reverse the effects of paralysis or, at least, to significantly improve the patient’s outcome. 

All surgery, of course, carries risks and patients must always be properly informed before they can be said to have consented before proceeding with any kind of operation. 

In scoliosis surgery patients will be warned about the risk of paralysis but, if even if it does, unfortunately, result, that in itself does not mean there is not a potential claim in clinical negligence, and patients affected by paralysis should always bear that in mind.

During Surgery

It is not advisable, in this day and age, for scoliosis surgery to proceed without spinal cord monitoring and patients should always ask if this is available. 

There are alternatives to spinal cord monitoring such as the intra-operative wake up test but medical experts used by Bolt Burdon Kemp have confirmed that they would not consider this adequate. They would not proceed without the spinal cord monitoring during scoliosis surgery and they would not recommend that any surgeon do so. 

Post-Operative Observations & Epidural

In the post-operative phase, neurological observations are, of course, crucial, particularly when, as is so often the case, an epidural is also administered for post-operative pain relief.

The epidural can in some circumstances mask the signs of neurological deterioration which, if not recognised and acted upon immediately, can result in permanent paralysis. 

Reversing the effects of Paralysis

Expert evidence has shown that if a surgical team is alerted quickly, the effects of paralysis can be reversed by taking the patient back to surgery and removing the metalwork. There is, however, a short timeframe for doing so – some evidence suggests a period of no more than 4 hours - after which time it is unlikely the effects can be reversed.

The provision of steroids is also identified as a potential benefit and although experts have said that steroids can assist in the immediate aftermath, there is unlikely to be a reversal of any paralysis if these are not given in a relatively short timeframe after symptoms arise.

Experts also say there are different schools of thought about the beneficial effects and whether or not there is enough evidence to prove that the administration of steroids can have the effect of reversing paralysis. In any event if a patient is still within the first few hours of experiencing neurological deterioration an expert is more likely than not to administer the steroids in order to give the patient the best possible chance at an improved outcome. 

At Bolt Burdon Kemp we have the legal expertise and experience to handle the complexities which accompany such clinical negligence claims. In fact, one of their own members of staff sustained a negligently caused paralysis as a minor which resulted from the failure to correctly monitor her neurological symptoms post-spinal surgery. 

We at Bolt Burdon Kemp have fostered good relationships with the kinds of highly specialised experts required in these difficult, and highly emotional, claims. We understand that the needs of a paralysed person will change many times in the years following the surgery, as they age and develop. 

Our excellent relationships with well respected experts in accommodation, care and occupational therapy ensure our clients feel reassured that their future needs are being taken into account and considered at the earliest stage.

Please contact our team here if you or a loved one has suffered from a spinal cord injury as a result of someone else’s negligence.

Vicki Reid

Bolt Burdon Kemp
Providence House, Providence Place, Islington, London N1 0NT
www.boltburdonkemp.co.uk
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