Deviation in the Standard of Care During Spinal (Lumbar, Cervical Spine) Surgery

Evaluate breaches in the standard of care using the questions and answers below to determine if there was a Deviation in the Standard of Care During Spinal (Lumbar, Cervical Spine) Surgery

Answer the following questions to find out if the standard of care was followed for your case.

  • What type of surgery did the patient undergo?
    Surgery for disc herniation/disc bulge/spondylolysis and spondylolisthesis
    Surgery for cauda equine syndrome
    Surgery for spinal injury
    Surgery for spinal infection
    Surgery for spinal tumor
    Why is this important?
    The primary indication for surgery in patients is increasing pain that is resistant to all conservative measures.
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  • With which of the following symptoms did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    
The significant features of herniated nucleus pulposus(herniated disc) are major muscle weakness with myotomal distribution, major sensory deficit with dermatomal distribution, and sciatica with pain radiating past the knee.

    (2008) 89 APMERE 9 1830-1845.e4 



  • With which of the following symptoms did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    
Surgery is performed on an emergency basis when a patient presents with a central disc herniation with bowel and bladder incontinence or retention and bilateral lower extremity weakness as these symptoms are indicative of cauda equina syndrome.

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  • With which of the following indications for surgery did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    
Risk factors are useful for identifying subjects at increased risk for a disease or for a particular outcome that results from a disease process.

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  • With which of the following indications for surgery did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    
Patients with spinal infections may need emergent surgery.

    (2008) 89 APMERE 9 1830-1845.e4 



  • With which of the following indications for surgery did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    
The red flags of cancer are past history of malignancy, age above 50 years, pain not improved when supine position, therapy or rest, unexplained weight loss, and pain for more than 4–6 weeks.

    (2008) 89 APMERE 9 1830-1845.e4 



  • Was a detailed medical history and physical examination performed? Why is this important?
    Answer this question
    
Screening for serious or specific conditions occurs as part of a history and physical examination and must occur at the initial assessment and subsequent visits. It is essential to complete a physical examination centered on the areas of pain with attention to related musculoskeletal components as well as related spine and neurologic structures.

    (2008) 89 APMERE 9 1830-1845.e4 



  • Did the patient have a history of trauma? Why is this important?
    Answer this question
    
Fractures of the thoracic and lumbar vertebrae are quite common injuries among patients suffering from multiple traumas, and approximately one third have concomitant spinal cord injury and variable neurologic deficit.

    (2013) 44 ESINJR 6 703-712 



  • Was the patient referred to a spinal surgeon? Why is this important?
    Answer this question
    
Once priorities and goals have been agreed on, referral to the appropriate professionals must be made in a timely manner. To deliver care requires a coordinated approach that allows sharing of skills and expertise. The skills of members from all professional disciplines must be utilized to enable all patients to achieve their maximum potential.

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  • Was a pre-operative evaluation performed? Why is this important?
    Answer this question
    
A pre-operative health assessment is performed within 30 days of planned surgery. At least a limited assessment is mandated by the Joint Commission on Accreditation of Healthcare Organizations on all patients, but a more thorough evaluation is necessary to obtain a comprehensive view of patient with risk factors.

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  • Was an informed consent obtained from the patient? Why is this important?
    Answer this question
    
The laws of most states require that surgeons obtain informed consent before providing treatment.

    (2011) 23 EOMSCA 3 475-484 



  • Were prophylactic antibiotics administered? Why is this important?
    Answer this question
    
Prophylactic antibiotics must be administered to decrease the rate of infections after spinal surgery. 

    (2009)9 ESPNJL 2 142-146 



  • Which of the following symptoms of post-operative bleeding did the patient exhibit? Why is this important?
    Answer this question
    
During any surgical procedure it is possible to injure the surrounding structures. In the event that injury occurs, it is necessary to identify those injuries immediately and take the necessary steps to correct them.

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  • Which of the following symptoms of post-operative nerve damage did the patient exhibit? Why is this important?
    Answer this question
    
During any surgical procedure it is possible to injure the surrounding structures. In the event that injury occurs, it is necessary to identify those injuries immediately and take the necessary steps to correct them.

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  • Which of the following symptoms of post-operative wound infection did the patient exhibit? Why is this important?
    Answer this question
    
Surgical site infection is suspected when there is erythema, drainage or fluctuance at the surgical incision.

    (2009) 89 ESRCNA 2 365-389 



  • Did the patient experience an intra-operative dural tear? Why is this important?
    Answer this question
    
During any surgical procedure it is possible to injure the surrounding structures. In the event that injury occurs, it is necessary to identify those injuries immediately and take the necessary steps to correct them.

    Click here for additional information at ClinicalKey.com 



  • Was padding of the patient’s bony prominences provided? Why is this important?
    Answer this question
    
Spinal cord injury patients are at an increased risk for pressure sore development in the immediate post-injury time period.

    (2007) 44 ECURPS 2 101-143 



  • Did the patient experience any iatrogenic injury? Why is this important?
    Answer this question
    
Mal-positioned instrumentation and over-distraction of bony elements are not uncommon causes of surgical fusion failure.

    (2001) 39 ERDCNA 1 1-29 



  • Were medications for pain relief prescribed? Why is this important?
    Answer this question
    
Specific pharmacologic interventions may be required to relieve pain.

    (2008) 89 APMERE 9 1830-1845.e4