Aa
I think I may have had the wrong surgery!
History-had left shoulder arm pain, numbness, weakness. Tried conservative treatment NSAIDS, analgesics, & rest without relief. Took oral steroid dose pack with good relief however symptoms returned. Had MRI showed central herniated disc of C6-7 and slight bulging of C5-6. Saw neurosurgeon 8 weeks after onset of symptoms and he said C6-7 "had to come out". Had relief of symptoms 2 weeks prior to surgery but had been off work and resting for about 10 weeks. Had Anterior Cervical Discectomy with Fusion. The plan was to do C6-7 as MRI showed this was the apparent problem and this was the only thing that was discussed with me in my preop visits and was the only procedure listed on my Op consent. Post op I was told in a brief 2 minute predischarge visit that he did level 5-6 and that I will continue to have neck problems due to arthritis but I should come back to see him and he would take care of it. I asked about C6-7 and was told that was not a problem. I was also given a very poor explanation as to why C5-6 was done and not C6-7. Was told due to my size and poor c arm images! I had a second opinion and a second MRI shows that C6-7 is still herniated and is unchanged from my preop MRI. I have not worked as a PACU RN for over 12 weeks now. I do not have symptoms at this time except for posterior mild neck pain 2/10.
My questions are:
How often does wrong level disc surgery of this type occur? (I know wrong site surgery is most common in orthopedics and neurosurgery)
Can you see from the anterior approach which disc has a central herniation that is causing cord compression or do you have to rely on C arm images or another means of determining the level in the OR?
Why would a neurosurgeon do level C5-6 when it is very obviously apparent on MRI that C6-7 is herniated? Why would he do C5-6 and leave C6-7 alone knowing that it is herniated causing cord compression?
I am very afraid that when I return to work pushing heavy beds and lifting patients my symptoms will return and I do not want to have that pain EVER again. The second neurosurgeon told me that in absence of symptoms he would not recommend any intervention at this time for C6-7. He would not comment on why I had C5-6 done instead of C6-7 he told me that I would have to discuss that with the operating surgeon. Risk management of the hospital has been involved and arranged the second opinion and second MRI. My gut is telling me that he did not know he did level C5-6 until after a CT scan was done post op. I have had my medical records requested but have not received them yet and have not seen the operating surgeon yet only his NP(nurse practicioner) as they told me the surgeon does not see patients post op for 90 days! What is that??? A surgeon does not see his patients post op for 90 days..... does that have to do with $$$ and insurance? The second neurosurgeon "the chief neurosurgeon" and this hospital set up an appointment to see the operating surgeon but my attorney recommends that I do not see the operating surgeon ever again or talk to any risk management people. I am needing answers but not sure what exactly to ask or do. Any thoughts would be helpful and appreciated.
My questions are:
How often does wrong level disc surgery of this type occur? (I know wrong site surgery is most common in orthopedics and neurosurgery)
Can you see from the anterior approach which disc has a central herniation that is causing cord compression or do you have to rely on C arm images or another means of determining the level in the OR?
Why would a neurosurgeon do level C5-6 when it is very obviously apparent on MRI that C6-7 is herniated? Why would he do C5-6 and leave C6-7 alone knowing that it is herniated causing cord compression?
I am very afraid that when I return to work pushing heavy beds and lifting patients my symptoms will return and I do not want to have that pain EVER again. The second neurosurgeon told me that in absence of symptoms he would not recommend any intervention at this time for C6-7. He would not comment on why I had C5-6 done instead of C6-7 he told me that I would have to discuss that with the operating surgeon. Risk management of the hospital has been involved and arranged the second opinion and second MRI. My gut is telling me that he did not know he did level C5-6 until after a CT scan was done post op. I have had my medical records requested but have not received them yet and have not seen the operating surgeon yet only his NP(nurse practicioner) as they told me the surgeon does not see patients post op for 90 days! What is that??? A surgeon does not see his patients post op for 90 days..... does that have to do with $$$ and insurance? The second neurosurgeon "the chief neurosurgeon" and this hospital set up an appointment to see the operating surgeon but my attorney recommends that I do not see the operating surgeon ever again or talk to any risk management people. I am needing answers but not sure what exactly to ask or do. Any thoughts would be helpful and appreciated.
Ggreg is SPOT ON!!!
I am an RN myself. Last year was the first time in 14 years I noticed a problem with my neck. I have a c4-c5 bulging disk just barely touching the spinal cord. I was advised to do nothing for now. I manage it with NSAIDs and rest. I do not do direct patient care on a floor anymore because we nurses know there is NO way not to lift and there really is NOT any "light duty."
I am an RN myself. Last year was the first time in 14 years I noticed a problem with my neck. I have a c4-c5 bulging disk just barely touching the spinal cord. I was advised to do nothing for now. I manage it with NSAIDs and rest. I do not do direct patient care on a floor anymore because we nurses know there is NO way not to lift and there really is NOT any "light duty."
GG,
Thank you so much for your response to my post. You where very informative and gave me another perspective on what may have happened. Couple things I should clarify though. First, my second neuro doc even though I think he is a great doc he is not willing to discuss this with the operating surgeon. He told me that I should have that conversation with the surgeon not him, he just pushed for an appointment with the operating surgeon before the 90 day post op appt. So really, I need to discuss this with the operating doc and with your input, now I have more informed questions I can ask. I REALLY hope your ideas on what may have happened with my surgery is the case and that it has been miscommunication that has lead to my confusion. The last thing I want is another surgery (and all that goes with it) if what happened was an error. That solution is not "so simple",as you put it, to the patient that has to go under the knife. I have decided to go to my appt with the original surgeon tomorrow and get the answers I need now to move forward. As far as work is concerned, I have just exhausted all my paid leave so I will need to get back to work soon. I am hoping for 6-7 weeks post op. It sounds like you have medical background so I can tell you in the real world there is no "lite duty" for RN's that do direct patient care nursing. I will deal with that when the time comes. Right now I just want answers and a healthy spine (or as good as i can get). Once again, Thank you for all your time and input it really means a lot to me. I will let you know what the surgeon's answers are to my questions. You are a five-star kinda guy!
sporty
Thank you so much for your response to my post. You where very informative and gave me another perspective on what may have happened. Couple things I should clarify though. First, my second neuro doc even though I think he is a great doc he is not willing to discuss this with the operating surgeon. He told me that I should have that conversation with the surgeon not him, he just pushed for an appointment with the operating surgeon before the 90 day post op appt. So really, I need to discuss this with the operating doc and with your input, now I have more informed questions I can ask. I REALLY hope your ideas on what may have happened with my surgery is the case and that it has been miscommunication that has lead to my confusion. The last thing I want is another surgery (and all that goes with it) if what happened was an error. That solution is not "so simple",as you put it, to the patient that has to go under the knife. I have decided to go to my appt with the original surgeon tomorrow and get the answers I need now to move forward. As far as work is concerned, I have just exhausted all my paid leave so I will need to get back to work soon. I am hoping for 6-7 weeks post op. It sounds like you have medical background so I can tell you in the real world there is no "lite duty" for RN's that do direct patient care nursing. I will deal with that when the time comes. Right now I just want answers and a healthy spine (or as good as i can get). Once again, Thank you for all your time and input it really means a lot to me. I will let you know what the surgeon's answers are to my questions. You are a five-star kinda guy!
sporty
Dear Sporty,
Concerning YOU seeing the original surgeon, that is a moot point, because your second neuro will be the one talking to the original surgeon, not you. So, stay in touch with your second neuro as to what comes out of his meeting with your first surgeon. This does not violate anything your lawyer recommends.
Concerning what was operated on, it is quite possible that when the surgeon got in to where he could visualize your spine, he saw that the C5-6 disc bulge was impinging on an important nerve, so he operated on that, whereas the C6-7 disc herniation perhaps was not pushing on any nerves, despite its rough shape, and the surgeon may be thinking the two vertebrae will probably fuse on their own. So, it could be your confusion upon being discharged from the hospital arose out of miscommunication or lack thereof, and hopefully when your second neuro meets with the original surgeon, the surgeon will explain it as I have suggested, or offer another reason, or admit he was in error. If he is in error, then the solution is so simple, he or another surgeon will simply operate again, and the surgery will likely not be charged to you... if it is, then since it would be an avoidable surgery, your lawyer can then get involved and request the charge be absorbed by the hospital.
As for you returning to work, my understanding is the surgeon must release you to work before you go back, which as far as I know would occur at the 90-day postop appointment. The surgeon must wait for you to heal before he can pronounce yay or nay to the success of the surgery, thus the three-month interval. Sure, in a perfect world, SOMEbody would have directly answered how come they did C5-6 and not C6-7, but since this did not happen, that's why your second neuro is going to get to the bottom of this with his upcoming meeting with your surgeon. Once he gets the clarification of what happened, any assurance of the need for a second surgery, arranging a new surgery date if called for, then you'll finally have your answers and a solution. And even tho your lawyer said never to see that doc again, I personally think you should keep your 90-day post-op appointment with the surgeon or any second surgeon you choose, unless a reoperation is needed, in which case that will add a new 90-day followup appointment.
You have good reason to not return to work yet. I am certain if you explain to your head nurse how you have to wait to be released by your surgeon before you can return to work, you will be granted whatever time off you need, even if part of it may be unpaid leave, depending on how much sick leave you have saved up. If a second operation is going to throw this into another month out or whatever, then in addition to your surgery being paid for, so too should any added time off from work from when you would have originally been released. But all of this is conjecture until your second neuro meets with the original surgeon. I'm just telling you in advance, so you don't suffer any more financial hardship than would be normal if the surgery had been correct. Again, your lawyer can recover any new extra postop time if a second surgery is done.
So, WHEN is your second neuro going to meet with the original surgeon? That will tell you everything you need to know. It will also create a conduit for you, between your second neuro and the original surgeon, for any further inquiries or appointment arrangements in the future, if any. If that meeting has been cancelled because of your attorney, in my view your health trumps any legal advice out there. You need answers and arrangements for any needed second surgery FIRST, and that meeting between the two neuros is essential to making sure you are going to be able to get well, return to work, and resolve any issues about errors, if any. So, you ask or your attorney should ask the second neuro to reschedule that meeting with the original surgeon... you need answers NOW and you need to find out what in the world actually took place!
I AM glad you are feeling better, but since you felt better even before the surgery, probably on account of you resting up, then as I said before, do not return to work until the original surgeon releases you to do so. One thing you might do is if you need to talk to the head nurse about your time off situation, if it looks like you may wind up with unpaid leave just staying out until the 90-day followup doc appointment, you COULD ask your boss for non-physical or "light" duty work until this whole thing is straightened out. Keep us posted, and hope my thoughts help you. I am not defending the original surgeon, for I surely appreciate how agonizing this confusion has caused you, not to mention anger if the surgeon made an error, and frustration over how your back is REALLY doing. I myself have been thru the mill trying to get docs to listen to me, to slow down with their talks with me, and just getting the ball rolling on any treatment. I just wanted to tell you a couple possibilities that may explain what happened and the future steps you may want to consider depending on what really happened. And I really think that second neuro is being truly helpful to you above and beyond by meeting with the original surgeon. The second neuro is a five-star kinda guy...keep him.
GG
Concerning YOU seeing the original surgeon, that is a moot point, because your second neuro will be the one talking to the original surgeon, not you. So, stay in touch with your second neuro as to what comes out of his meeting with your first surgeon. This does not violate anything your lawyer recommends.
Concerning what was operated on, it is quite possible that when the surgeon got in to where he could visualize your spine, he saw that the C5-6 disc bulge was impinging on an important nerve, so he operated on that, whereas the C6-7 disc herniation perhaps was not pushing on any nerves, despite its rough shape, and the surgeon may be thinking the two vertebrae will probably fuse on their own. So, it could be your confusion upon being discharged from the hospital arose out of miscommunication or lack thereof, and hopefully when your second neuro meets with the original surgeon, the surgeon will explain it as I have suggested, or offer another reason, or admit he was in error. If he is in error, then the solution is so simple, he or another surgeon will simply operate again, and the surgery will likely not be charged to you... if it is, then since it would be an avoidable surgery, your lawyer can then get involved and request the charge be absorbed by the hospital.
As for you returning to work, my understanding is the surgeon must release you to work before you go back, which as far as I know would occur at the 90-day postop appointment. The surgeon must wait for you to heal before he can pronounce yay or nay to the success of the surgery, thus the three-month interval. Sure, in a perfect world, SOMEbody would have directly answered how come they did C5-6 and not C6-7, but since this did not happen, that's why your second neuro is going to get to the bottom of this with his upcoming meeting with your surgeon. Once he gets the clarification of what happened, any assurance of the need for a second surgery, arranging a new surgery date if called for, then you'll finally have your answers and a solution. And even tho your lawyer said never to see that doc again, I personally think you should keep your 90-day post-op appointment with the surgeon or any second surgeon you choose, unless a reoperation is needed, in which case that will add a new 90-day followup appointment.
You have good reason to not return to work yet. I am certain if you explain to your head nurse how you have to wait to be released by your surgeon before you can return to work, you will be granted whatever time off you need, even if part of it may be unpaid leave, depending on how much sick leave you have saved up. If a second operation is going to throw this into another month out or whatever, then in addition to your surgery being paid for, so too should any added time off from work from when you would have originally been released. But all of this is conjecture until your second neuro meets with the original surgeon. I'm just telling you in advance, so you don't suffer any more financial hardship than would be normal if the surgery had been correct. Again, your lawyer can recover any new extra postop time if a second surgery is done.
So, WHEN is your second neuro going to meet with the original surgeon? That will tell you everything you need to know. It will also create a conduit for you, between your second neuro and the original surgeon, for any further inquiries or appointment arrangements in the future, if any. If that meeting has been cancelled because of your attorney, in my view your health trumps any legal advice out there. You need answers and arrangements for any needed second surgery FIRST, and that meeting between the two neuros is essential to making sure you are going to be able to get well, return to work, and resolve any issues about errors, if any. So, you ask or your attorney should ask the second neuro to reschedule that meeting with the original surgeon... you need answers NOW and you need to find out what in the world actually took place!
I AM glad you are feeling better, but since you felt better even before the surgery, probably on account of you resting up, then as I said before, do not return to work until the original surgeon releases you to do so. One thing you might do is if you need to talk to the head nurse about your time off situation, if it looks like you may wind up with unpaid leave just staying out until the 90-day followup doc appointment, you COULD ask your boss for non-physical or "light" duty work until this whole thing is straightened out. Keep us posted, and hope my thoughts help you. I am not defending the original surgeon, for I surely appreciate how agonizing this confusion has caused you, not to mention anger if the surgeon made an error, and frustration over how your back is REALLY doing. I myself have been thru the mill trying to get docs to listen to me, to slow down with their talks with me, and just getting the ball rolling on any treatment. I just wanted to tell you a couple possibilities that may explain what happened and the future steps you may want to consider depending on what really happened. And I really think that second neuro is being truly helpful to you above and beyond by meeting with the original surgeon. The second neuro is a five-star kinda guy...keep him.
GG
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