Anterior Cervical Surgery Malpractice
Anterior Cervical Surgery Malpractice
A recent study illustrates the hazards of anterior cervical sugery. One of the complications from poor surgical skill is injury to the esophagus and hypopharanx.
Management of the cervical esophagus and hypopharynx perforations complicating anterior cervical spine surgery.
STUDY DESIGN Five cases of esophageal or pharyngeal perforation diagnosed during or after anterior cervical spine surgery are presented.
OBJECTIVE To outline a protocol for the early diagnosis and treatment of iatrogenic (doctor caused) pharyngoesophageal perforations.
SUMMARY OF BACKGROUND DATA Pharyngoesophageal perforations after anterior cervical spine surgery are uncommon or [u]rarely reported[/u] complications. They may have serious functional consequences, including death, if they are not diagnosed promptly and treated effectively. These potentially fatal conditions require a surgical and medical therapy.
METHODS Clinical course, diagnostic tools and guidelines for the management of five patients presenting esophagopharingeal perforations are illustrated.
RESULTS These five cases resulted in definitive healing of the laceration without functional consequences.
CONCLUSION We believe that awareness of these complications and their causes, prompt recognition of the symptoms and immediate and multimodality therapies are essential tools to achieve successful results.
Reference: Spine. 2003 Aug 1;28(15):E290-5.
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Another recent study evaluted the incidence of nerve deficits caused by anterior cervical disc surgery despite monitoring to prevent such occurrences.
Two cases of quadriparesis following anterior cervical discectomy, with normal perioperative somatosensory evoked potentials.
Two cases illustrate an uncommon failure of perioperative somatosensory evoked potential (SEP) monitoring to detect iatrogenic lesions causing temporary quadriparesis during straightforward cervical surgery.
In both cases, anterior cervical discectomy at one or two levels was undertaken with bone graft and titanium implants, and cortical SEP were monitored to alternate stimulation of the left and right median or ulnar nerves. The SEP showed only minor changes during surgery, not considered pathologically significant, and were normal when recorded postoperatively.
Both patients, however, experienced marked postoperative limb weakness or paralysis. Motor evoked potentials (MEP) recorded postoperatively to transcranial magnetic stimulation were absent. The clinical motor deficits resolved over the ensuing months.
In spite of the normally low incidence of “false negatives,” in these two cases SEP monitoring failed to detect a iatrogenic lesion causing moderate to severe, though temporary, motor impairment. Monitoring of MEP may be considered as an alternative to SEP during anterior cervical procedures, while combined monitoring of SEP and MEP may be the ideal.
Reference: J Neurol Neurosurg Psychiatry. 2003 Feb;74(2):273-6.
Please share your experiences, side effects, and opinions about Cervical Surgery in the Comments section.
Ask your doctor if minimally invasive spinal surgery is an option instead of spinal fusion. If spinal fusion is recommended make sure to ask how many a surgeries a year your doctor performs, how many are successful, and what percentage of his patients need revisions.
Please note the utilization rate for spinal fusion for the years 1993 to 2003 for cervical, thoracolumbar, and lumbar fusions increased by 89, 31, and 134%, respectively.
Perhaps, the change in reimbursement rates favoring spinal fusion has more to do with that trend?
Spinal-fusion surgery is expensive, with the average hospital bill more than $34,000, excluding professional fees.2
Find out more facts on the business of spinal surgery.
Epidemiology of Spinal Surgery: Rates and Trends
Reference: 1) Neurosurgery. 59(1):15-20, July 2006
2) NEJM. Volume 350:722-726, February 2004.
December 19th, 2003 at 6:49 pm
I recently had cervical surgery and I now have only partial use of my left arm and my voice has changed. Is this normal? Can it be corrected by therapy?
Waiting to hear from someone. Please!!
Max
December 27th, 2003 at 5:03 pm
Did you have the use of your left arm and full use of your voice before your neck surgery? How long ago did you have it done?
January 24th, 2004 at 5:24 pm
My wife underwent 3 level ACDF with hardware implantation 3 years ago. Recovery was great for 3 weeks (back to work!)Pain in neck & upper back suddenly increased and continued for 9 months. Wound up in ER with retroesophageal abscess (Infection between esophagus & spine) Abscess re-occurred 2 more times with emergency surgery required each time before small tear was found during 3rd. time (Gee, wonder how that happened?)7 surgeries all together. Now has complications too numerous to list. Life is not the same. Legal action almost impossible in Doctor’s paradise of Virginia. Lesson: “SURGERY IS ALWAYS, ALWAYS LAST RESORT!!”
March 28th, 2004 at 2:10 pm
i had cervical disc in 2002,at level 5,6,7, after surgery my throat was sore as crap, couldn’t talk, hurt like crazy to swallow right side of my face was drooping after begging f for the doctor to see me, he finally came in said everything was normal and left.i went home. was back in the hospital within a week for 3 days. an infection was in my throat,fluid like a cyst. he finally called for an e.n.t doc. to check my throat out the right side of my vocal cord was paralyzed.so i started going to the voice disorder hospital at wake forest,n.c. had to have a injection about 5 months after my surgery so i could talk better.it worked. one year later was suppose to a wire put in my vocal cord in nerve transplant, but the insurance would not pay was out of network, which was a good thing cause they didn’t tell me with this kind of surgery my breathing would get even worse would proably have to a trach. well needless to say i didn’t have the surgery 2 yrs. later the problems keep building up i now have sleep apnea, numbness in my right arm, nerve damage to my face on the right side, get choke alot, voice is weak, can’t sing any more, this doc. really did a number on me, but i can’t find a lawyer to take my case,all of them say i’ve to pay up from thousands of dollars, my life has totally changed forever, and not for the best.
May 24th, 2004 at 11:42 am
My father had anterior cervical surgey 2 weeks ago. Right after surgery he had use of arms, but the following day had very limited use most likely due to swelling. They performed posterior surgery the next day due to “things having shifted” and now he has no use of his shoulders. He has limited to use in his left arm, but can’t raise either one. He is still in rehab, but not progressing well.
June 3rd, 2004 at 8:17 pm
I had anterior cervical fusion C3-7 on March 25, 2004. I am coming along slowly, but pain is much less than prior to surgery. I had little feeling on all of right side, and after surgery pain and loss of feeling in left arm. Everything is coming back slowly. I just started P.T. yesterday.
June 4th, 2004 at 11:43 pm
I had anterior cervical fusion (C3-7) on May 27, 2004. My throat was extremely sore immediately following surgery. I still get hoarse at times. I’m dealing with muscle spasms that are nothing compared to the pain before surgery. I occasionally experience a little numbness in both arms (more in the right arm). However, I’m more concerned with the tightness that I feel in my neck and throat. Although it may just be my imagination. Please advise.
June 25th, 2004 at 2:29 am
I had C5-6 Fusion in 1994. Was coughing badly and let out of hospital too soon. I called Dr (went on vacation) and on call said take m.relaxers. Called again next day after coughing up nasty stuff and told I was taking too much pain meds. Long story 10 days after surg went to OR and had coughed bone out of place. Had same surgery (bone out of other hip) again and then all bets off. I couldn’t eat, talk or move neck. I ended up with FMS and now in 2004 I have lots of neck problems and now lower back disc degeration. I was crying and looking up info. Thought surgery might be the answer but now scared to death. I am on Morphine, anti-depressants, sleep meds and now have diabietes. Thanks for posting and sharing your stories. Surgery is not the answer we hope it will be.
June 27th, 2004 at 10:10 pm
I had anterior cervical disc fusion on C5-C6 5 weeks ago. The pain is out of my arms but my neck hurts awful now. Even on pain medication, I still hurt. I have burning sensation at the back of the base of my neck and I have started having headaches every day now for about 2 weeks. After my week check up, i was okay but now the pain is worse. I am not doing anything to aggivate my neck. I have called the doctor and am told that is normal after surgery but most everyone I talk to says that after a couple of weeks they were fine. I go to see the doctor this week and my job is really physical. I don’t want to be sent back too soon and do more damage. Please let me know if anyone has had problems worse since surgery. Thanks
July 5th, 2004 at 12:14 pm
I’m having C5-6 diskectomy w/ plating tomorrow; neurosurgeon is doing it. Never had any type of surgery at all. This is my first (I’m 39 yo). Can anybody give me a good run down on what I can expect immediately after in terms of what type of pain, the level, and just what I can expect to feel like? I’m pretty nervous; all I hear are horror stories. I’d like to know what the average patient should expect. thanks.
July 8th, 2004 at 6:31 am
Went for fusion and bone implants – C5,C7 & C6 on 16.5.2004. Waking up afterwards with a terrible sore throat. The throat cleared up the second day after surgery. Since then I’ve taken rarely any pain tablets but still suffer from occational nerve pain in the arms. The most traumatic of the whole episode was, to be so darn dependent on the people around me. Not to be able to do anything like gardening or painting or glass work. Not even walking the dogs. And no driving. The boredom nearly made me drop my basket!.Recovery takes up to 6 month I’m told and can not wait to be without pain.
July 13th, 2004 at 9:27 pm
Three weeks ago on 7/22/04 I had ACDF c5-6 with a titanium plate. This surgery was for the right side. The pain in my arm has gone away but this arm still goes numb at many different times!!! More than before. I also have started in the last 3-4 days experiencing severe deep pains in my upper back/neck area. This is in an upside down “U” shape on the right and left side from the neck to upper shoulder. Is this normal? Has anyone experienced this and also my first check up with the doctor is still a week away should I call and talk about this?
July 23rd, 2004 at 8:48 am
I had Anterior Cervical Fusion with instrumentation on 7-2-04. This followed Anterior Cervical discectomy at C7-T1 2 years prior. My left arm numbness and weakness has totally resolved, and the pain I experienced before the surgery is much, much less. I, however have an extremely hoarse voice and have difficulty drinking fluids without coughing, gagging and choking. An ENT friend scoped me and found that my right vocal cord is paralyzed. Possible collagen injection to that right vocal cord in the future. I however would gladly have this hoarseness and be almost pain free- there’s no trade off for me.
August 2nd, 2004 at 7:04 am
I had C^ ^& ACDF 2 weeks ago here at VA in Minneapolis. I had a laminectomy done last year that did not work. I subsequently suffered a major heart attack 3 weeks later. Since this last surgery on July 19th I still have a very sore throat and it hurts to speak. My voice is very low, almost like a whisper. Is this normal? Seems the loss of strength and severe pain that I had prior to surgery in my right arm is coming back. I had ACDF C5 C6 in 1991. I am 60 years old, turned down twice now by social security. They say I can do the job I had 20 years ago as an army recruiter. It is very painful to type this and takes much time. My regular employment is that of telephone sales. But with not much voice and very slow on the computer I feel I am done for in the working world. Would appreciate any comments.
August 9th, 2004 at 12:05 am
I just had surgery on my anterior cervical diskectomy on 08/04/2004, I feel worse 5 days later than I did on the 3 day i left the hosp. and what is really worrying me is my throat it is not all that sore it is just real tight and i can not get my food to go down with out swallowering several times and with water and i have been real sick on my stomach, But my swallowering is my main concern and yes my voice is too it sounds like I have been run over by a truck, if you can please respond to me at my e-mail address so when i check my e-mail in the morning someone out there will have a good answer for me.
August 14th, 2004 at 2:35 am
My Dad had a cervical fusion on C2-4 in July 2003. The surgery went well and he was able to return to work a few days later. He had a anterior cervical decompression on C3-7 a month later and was rendered a quadriplegic soon after the surgery. In the weeks following his surgery, he experienced severe pain in his neck, arms and shoulders. His motor skills have not improved much over the past year and he has been in a total asist care facility since the surgery. My Dad is 76 years old. I would like to hear feedback from anyone who has undergone a anterior cervical decompression procedure and would like to know how you have progressed since the surgery. I would greatly appreciate your advice and comments.
August 19th, 2004 at 1:47 am
In response to your message I didn’t read anything regarding post follow-up diagnosis of what may have led to your fathers outcome. I would like to know if you or anyone is aware of how common these kinds of results do occur? How significant is someone age if over 70 years? Peace to your all
August 24th, 2004 at 8:00 pm
I had an anterior cervical diskectomy of C5-6 and C6-7 with a titanium plate in April of 2003 due to a pinched nerve which was causing extreme pain down the left arm. I think I did fine with the surgery except my voice got worse after about a week. It was down to a hoarse whispher. It is finally back to close to normal now over a year later. I was sent to an ENT 3 months after surgery and discovered that the right vocal cord was paralyzed. I often get voice fatique and feel as if my throat is swollen inside. The ENT said we could do surgery later on and pull the paralyzed vocal cord over so that the good one does not have to work as hard, but I am concerned about having this done as I’m afraid of the possibility of totally losing my voice. But my main concern is that both my arms constantly ache and sometimes burn now. I feel that I am continually losing strength in both arms. By mid-afternoon my neck feels almost as if my head is too heavy for it. Also my arms and legs feel heavy at times and ache. My upper back also aches a lot which it never did before either. I am tired all the tired, frustrated that I cannot do anything any more, and afraid of losing more strength in my arms. I can’t even hold a new born baby without my arms getting tired after a few minutes and being afraid of dropping the baby. A 2 liter of pop hurts to pick up. I know that recovery takes time, but I feel I should be reovered by now instead of feeling worse. It is all I can do to get through work (I’m a secretary) and once I get home I’m too tired to even do anything. I spend the weekends recouping and resting up just to get thru the next week. Does it get better? Am I going to continue to lose strength in my arms? I know I have some deaden nerve damage in the arms, but was told that probably happened before the surgery. Just what does that mean and does that have anything to do with the loss of strength? Pain wise I am not in the extreme sharp pain I was in before the surgery, but the constant aching is wearing me down. Do you have any ideas or suggestions?
September 13th, 2004 at 9:46 am
I am a respiratory therapist . I have had 4 fusions over the last ten years. First was c-3 emregency procedure, donor bone , second two years later c-4 c-5 hip chip used. The hip hurt and still does from wherethey took the bone for fusion . two years afterthat had c-6 ,, and 3 months ago i had c-2 with 60% spinal cord compression , I waited till icould no longer feel or move my thumbs basically till the last possible time to have surgery . This last one is an amazing new technique that uses a implant that dissolves but as it does it generates bones growth , so my body is actually growing its own bone for the fusion. I had no c-collar on the next day and went home, I do have vocal cord paralysis which i still have ,As previously described i cannont speak in high tones and my throat feels like there is a knot in it at times. This takes sometime as long as a year to go away but it usually does .I keep trying the higher cords out , stimlating them and although they are still not functioning it does help in getting them back .Throughout my experience with this type of recovery is to keep inmind the trauma my body has gone through . Just because the acute and extremely painful herniated neck is fixed the body has bared the brunt of carrying the necks job for awhile before surgery . Poor posture and muscles used that are not their intended purpose takes time and concous effort to correct and heal .Regardless of how many times i go through this i always find my minds timeline is ALWAYS ahead of my bodies when it comes to when ithink i should be over this and back to “normal “. When i went infor this lastsurgery i had put off surgery to the very last minute ,my thumbs and hands were totally numb and i was loosing use of them, now i am upset when my fingers tingle .It is at these times i need to take a deep breath and remember the worst part of going thrugh this illness isnt the pain although that totally sucks !!,, it is the frustration .It is the patience and change in thinking from anything we ever have done to get reacquanted with our bodies and recognize how distorted our bodies had become prior to surgery .What i have always done after each surgery is slowly test my limits ,and do little things to help with the rewiring .. which is basically what your body needs to do after any cervical assault . )There are parts of us that have been numb and still used for years , other parts used to compensate for parts that when used caused unbearable pain , They need to heal as well as the direct culprits .If you need more rest there is a reason ,, your body is telling you it is doing its best but the healing process uses an enormous amount of energy. That is part of the frustration .. we cannot dictate a reasonable amount of down time because the healing process , most of the time, does not want to negotiate ..it dictates .. thenerve damage you described , i have experienced,and if it is true permanent nerve damage that is irreversible ,, you will learn to compensate and it will eventually not be a foreign feeling ,,function has a way of being a byproduct of testing limits .slowly allowing the rewiring of electical signals throughout the affected areas to find new pathways ,, Not always a pleasant and pain free experience but is a sign of recovery and return to whatever you willhave to work with and is the new norm ,, all this body work is constantly in competition for the minds timeline.which equals frustration .And finally the loss of strength.. it will come back ! your muscles have been the witness to the traffic jam going on in your neck and spinal cord.especially recoverying from surgery they are exausted and need to be put through grade school again .. be kind to them but give them daily workout in slow increments,, for me at least even as much as molding therapy clay in my hand throughout the day helps get started in retraining my muscles to settle back in and get back to work for their intended purpose,, they no longer have towork overtime and get beaten up ,OverallTHE BEST THING that has always been apart of physical recovery for me is swimming or getting into a pool !!!!! The bouyance of the water allows me to isolate and work on affected areas and areas that need to slowly be reaquanted with movement and function .. i hope my 2 cents worth has at least given you a little bit of an answer ,,
October 13th, 2004 at 9:25 pm
I had ACDF 4 weeks ago. I woke up in the Recovery Room and my left arm pain was gone but my right thumb was numb which I did not have pre-op. I noticed right arm weakness in addition to the numbness but my surgeon said it would go away. Today my right arm is painful and thumb continues to be numb. I’m worried but don’t want to be a complainer.
October 17th, 2004 at 5:39 pm
I had a ACDF performed in Nov 2002. I felt better after surgery compared to how I was before hand. Never in my life did I feel like a mamed animal hit by a car before the surgery. But my head pain has never gone away. It doesn’t start unless I bend over. I wish it would go away. I still have numbness in my face, down my right arm, some bladder difficulties, at times shooting pain down my right leg. I drop things all the time with my right hand. My middle fingers go numb at times. And the pain in the back of my neck if I do to much activity is an extreme. The head aches every dag gone time I bend over. I am glad to be here. I told my Neuro Dr this a year ago, but he said it was nerve damage, the posterior longitudinal ligament was severed in the accident and the doctor fixed it. What is pain. Which level of extreme. Pain meds don’t work any more, they hurt your stomach. Muscle relaxers help the knot I get in the back of my head that occurs when I bend over, but I can’t perform my daily tasks as well. What has happened. I live daily in pain. But I try my hardest to continue. I can’t work my job all messed up on the meds, I would hurt someone. So I go without the meds and feel aweful. I need some info on what is going on. Please be honest. I am in the medical profession, just didn’t specialize in Neuro.
February 1st, 2005 at 2:05 am
had 3 cervical fusions, c3c4c5, with hardware, and cadavier bone, surgery 2 years old, i now have bone spurs, both armss and hands numb and tingling 24/7 both legs and feet numb and tingling 24/7, legs feel heavy when walking, left legs gives out in pelvic area with a off and on shooting pain, decided to stop seeing doctors and taking pain meds, trying to do this on my own, mind over matter, heating pads etc… from feedback i know i will have the donmino effect, my question is? will i get better? or worst? i went back to maid work after six weeks, what should i do are not do?
May 5th, 2005 at 7:07 pm
back in 99 i had thi surgery on c6 &c7 and titanium plate put in.never regained strength in left arm.6 months after surgery i started hurting again but i had to hide pain and lie about surgery to get a job to feed my kids.now no strength in left arm and knumb.losing right arm too.just found out i have c5 & c6 gone now.im screwed for life now.dont know wether this surgery is worth it or just a way to get our money.promised me 100% and now if i was a horse they would shoot me.im only 38 what am i gonna be feeling at 60. good luck to anyone going thru this it is a physical and mental nightmare!!!!!