Professional and ethical approaches to characterize complications in elective spinal neurosurgery. Never events in lumbar discectomy

Abstract

Any surgical intervention is associated with the possible development of complications. Surgical complications are traditionally an unpopular topic for discussion, but in recent decades they have received increased attention, due to both medical and economic factors. This review discusses the general concepts that characterize the negative consequences of surgical interventions in spinal neurosurgery: complications, adverse events, sentinel events, never events, collateral adverse outcomes. Classifications are given that allow systematizing these negative phenomena.

Surgical treatment of the lumbar disk herniation is the most frequently performed spinal surgery. The true number of lumbar discectomies is difficult to estimate because this procedure is often not an isolated surgical intervention, but a step in a larger one. Being a routine surgical procedure, discectomy, performed in one or another way depending on the preferences of the surgeon and available equipment, is characterized by a rather low relative frequency of adverse events and complications compared to other types of spinal surgery. However, due to the significant number of interventions, the absolute figures may present a medical and economic problem. Most authors refer to the classic triad of “wrong level, wrong side, wrong patient” and foreign bodies in the area of surgical intervention as obvious medical errors. Damage to the intestine or peritoneum, trauma to the great vessels and trauma to the nerve roots are considered serious complications, but not always medical errors. The other most commonly reported adverse events of lumbar discectomy are durotomy, neurological complications, surgical wound complications, recurrent disc herniation, and reoperation.

Until now, no clear classification of the negative consequences of lumbar discectomy, which would allow to verify the relationship between intraoperative adverse events (both surgical and anesthetic) and postoperative complications has been developed. In addition, it is extremely difficult, based on the criteria available in the literature, to identify a medical error in a number of iatrogenic complications, which requires further comprehensive study of the problem, since it has not only medical, but also legal consequences.