According to the Spinal Injuries Association, 2,500 people in the UK suffer a life-changing spinal cord injury every year, and 50,000 are living with a spinal injury. Some of these are from trauma – road traffic and other accidents. Others are the result of illnesses or conditions such as cauda equina syndrome or spinal infections.
This article looks at some of the most common complications from spinal injuries, and the claims that frequently accompany them.
What is a spinal cord injury?
A spinal cord injury is damage to the spinal cord or the nerves at the end of the spinal canal – the cauda equina. It may occur to any part of the spinal cord, and often results in symptoms such as changes in sensation, strength and bodily functions.
Most spinal injuries are fortunately not particularly common. Many are also related to damage to the nerves extending out of the spinal cord.
The spinal cord is a tube-like structure passing from the brain stem towards the bottom of the spine. It consists of nerves that carry signals between the brain and the rest of the body.
Three-quarters of the way, the bundle of nerves extends below the spinal cord into the cauda equina – Latin for ‘horse’s tail’, because of its appearance. The cord has a protective cover with three membranes or meninges.
The spinal cord passes through the spinal canal which itself is protected by the spine, composed of 33 vertebrae. Between the vertebrae are discs, which cushion them, protecting bones from the pressure generated by activity such as walking and running.
The most common spinal cord injuries
Syringomyelia
Syringomyelia is a rare condition in which a fluid-filled cyst, or ‘syrinx’, forms within the spinal cord. As it expands over time, it puts pressure on the spinal cord, causing pain, weakness in the arms and legs, numbness, and stiffness.
Syringomyelia may be caused by injuries, tumours or inflammation around the cord, including meningitis – or someone may be born with it.
Arachnoiditis
The arachnoid is one of the three membranes surrounding and protecting the spinal cord. Arachnoiditis is where it swells, causing pain – often, this is described as ‘stinging’ or ‘burning’. It can then form scar tissue so that the nerves of the spinal cord stick together.
Arachnoiditis can have a few different causes: direct injury to the spine, infection or irritation by chemicals, including dye used in some diagnostic tests. Injury or compression of the spinal cord, for instance from degenerate discs or stenosis (narrowing of the spinal column), can cause arachnoiditis.
Unfortunately, there is no way of curing the condition and the main treatment is to manage the pain.
Spasticity
Spasticity is a condition where damage to nerve pathways makes muscles contract, giving rise to abnormal tightness in the muscle. It is often found in people with cerebral palsy or multiple sclerosis, who have had strokes or injuries to the brain or spine.
Spasticity is most common in the legs, although it can affect muscles elsewhere.
Cardiovascular complications
Spinal cord injuries may increase the risk of heart disease. Again, this is due to nerves not functioning as they should.
Signals from the brain regulate blood pressure and heart rate by controlling how much blood vessels contract. Disruption to nerves within the spinal cord can affect those signals, lowering blood pressure and heart rate.
Autonomic dysreflexia
Autonomic dysreflexia is a condition where disruption to the nerves in the spinal cord interferes with signals to and from the brain. The condition is most apparent in people with injuries above the sixth thoracic vertebra.
A stimulus below the level of spinal injury triggers an overreaction by the autonomous nervous system – the system controlling breathing and heart rate. This causes the sudden, uncontrolled onset of high blood pressure. It can be triggered by relatively minor stimuli, such as a full bladder, blistered skin or sunburn.
High blood pressure can cause stroke from haemorrhage, seizure or cardiac arrest. This is a life-threatening condition.
Respiratory complications
Spinal cord injuries can impair the breathing system, particularly where the injury is in the cervical spine (neck) or upper thoracic spine.
This is because the nerves here can impact the four groups of muscles controlling the diaphragm. Any loss of diaphragm function reduces the lung’s capacity. This increases the risk of congestion in the lungs and of infection.
Respiratory complications are the most common cause of illness and death after a spinal cord injury.
Bladder problems
Spinal cord injuries can disrupt the nerves to the bladder and bowel. This is referred to as ‘neurogenic bladder’.
Some people may need to pass urine more frequently, more urgently, leak urine or become incontinent. Others may experience difficulty emptying the bladder. A build-up of urine in the bladder can damage the kidneys.
Bowel dysfunction
A spinal cord injury can also damage the nerves controlling bowel function. The brain may not properly control how the intestines function, meaning stools take longer to pass into the large bowel, resulting in constipation. Some people may also become incontinent.
Pressure sores
Spinal cord injuries can increase the risk of pressure sores. People may have a lack of feeling so that they do not feel pain when the skin starts to become damaged. They may also spend more time immobile, sitting or lying too long in one position without moving or turning. They could also find themselves lying on hard objects such as catheter connectors. Pressure sores can lead to infection and, in some cases, to sepsis or amputation.
Neuropathic pain
Around 60-80% of people with spinal cord injuries experience significant pain. Pain may be due to nerve damage or problems in the muscles, skeleton or joints arising indirectly from the spinal cord injury.
Nerve pain is often described as burning, stabbing or tingling. It is thought to arise from the brain misinterpreting signals it receives from the injured area.
DVT
Deep vein thrombosis (DVT) and pulmonary embolism (PE) are serious complications of spinal cord injury. They are most common in the six-month period after injury. DVT is a clot the forms in a deep vein, normally in the calf or thigh. The clot can break off and make its way to the lung, where it causes a PE. This can be life threatening. The risk can be reduced by taking anticoagulation – blood thinners – to prevent clots forming.
The most common types of spinal injury claims
If you’ve faced a spinal cord injury and you’re thinking of pursuing legal action, it might be helpful to familiarise yourself with the most common types of spine surgery claims. Broadly speaking, there are five common types of claim, and each can come with its own litigation process.
The main types of spinal injury claims are:
1. Cauda equina syndrome claims
The cauda equina is a bundle of nerves at the bottom of the spinal cord. Damage to these nerves can cause devastating disability, including loss of bladder and bowel control, loss of sexual function, numbness and paralysed legs.
Sometimes, cauda equina syndrome comes on suddenly when a disc prolapses and puts pressure on the cauda equina, so doctors look for ‘red flag’ symptoms, such as:
- Sciatic pain in both legs (but, not just one)
- Weakness or numbness in both legs
- Difficulty passing urine
- Loss of bowel sensation and control
- Numbness in the ‘saddle’ area
There have been several cases since 2015 where patients were not properly advised about the risks of spinal surgery and suffered injury. Those cases have succeeded where there was good reason to think that, with the right advice, the patient would not have run that risk.
2. Surgical error claims
There are many different types of spinal surgery. They all involve some risk of damage to other structures – the spinal cord, nerves and arteries. Damaging any of these structures through surgical negligence can cause serious injury. Nerve injuries are one of the most common causes of spinal surgery claims.
According to a recent study, 23% of spinal surgery claims arose from surgeons causing nerve damage and 12% involved damage to the spinal cord.
In one case, a surgeon carried out a spinal fusion using a metal cage and screws, but one of the screws was wrongly placed and damaged a nerve. Other injuries arose when surgeons used the wrong technique or the wrong equipment.
3. Anticoagulation errors and bleeding claims
Some cases concern serious bleeding after surgery. In one recent case, a woman was given anti-coagulation medication (which increases the risk of bleeding) to reduce the risk of deep vein thrombosis.
However, it was given very soon after surgery – three hours later – when normal practice is not to do so until 12 to hours later. She suffered a serious bleed which caused pressure on the spinal cord and left her disabled. The court found that giving anti-coagulation so early was negligent.
Read more about this case in our article ‘Bleeding After Spinal Surgery: A Seriously Disabled Woman Recovers Damages’.
4. Lack of consent claims
It is important that patients understand the risks and benefits of their treatment, but also of the alternatives. The law changed in 2015, with a decision of the Supreme Court which aimed to ensure patients are well informed to make the right decision and there is not a lack of informed consent.
There have been several cases since 2015 where patients were not properly advised about the risks of spinal surgery and suffered injury. Those cases have succeeded where there was good reason to think that, with the right advice, the patient would not have run that risk.
5. Mismanagement of spinal infection claims
Infections involving the spinal cord need to be managed quickly, if they are not they can cause permanent damage. Nearly 10% of spinal surgery claims involve the management of infection.
In one very sad case, a young man was left very disabled after delays in recognising his spinal infection.
He developed leg and back pain and started to feel unwell, so was taken to his local hospital. Staff failed to realise that he was seriously ill with an epidural abscess, and they took too long to carry out blood tests and scans.
The infection spread into the intradural space within his spinal cord, he developed meningitis, ventriculitis (inflammation of part of the brain) and hydrocephalus (a build-up of cerebrospinal fluid within the brain).
He ended up with paralysis of his arms and legs – tetraplegia.
Making a claim
If you have suffered an injury due to negligent spinal surgery and would like to learn more about making a claim for compensation, our team of expert spinal injury solicitors are here to help.
Contact us now for a free, no-obligation assessment of your claim.
Spinal injuries and claims: Key questions
What are the most common causes of spinal cord injury?
A spinal cord injury is commonly caused by:
- Road collisions
- Falls
- Sports injuries
- Violent crime
- Birth injuries – these can harm the cervical spine
- Other forms of medical negligence.
Not all spinal cord injuries are eligible for a compensation claim – for instance, if you fall and no party is liable, it may not be possible to claim.
What are the two most commonly injured areas of the spine?
The most commonly injured areas of the spine are the lumbar spine, (within the lower back), followed by the cervical spine. Though cervical spine injuries are less common, these can cause more significant damage, since nerves connected to the neck serve the arms and other functions of the upper body.
