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Intraoperative Monitoring in Back Surgery and Its Importance in Malpractice Actions

On behalf of Cohn Lifland Pearlman Herrmann & Knopf LLP | Sep 20, 2016 |


A patient is wheeled into the operating room. The surgeon is present. The anesthesiologist appears and then a group appears with computers and electronic monitoring equipment. You probably have not been told who they are before you entered the room and it probably will not be any part of your focus as you are put to sleep.

However, after the surgery you wake up with problems. You have neurological deficits. You cannot move your foot, you have no sensation in your body and, worst of all, you do not know why and the answers do not make sense. You did not expect any of these problems to arise.

It is the rare physician who will admit to an error. A review of the medical records does not reveal any cause for the problems. Your attorney feels that there are no answers and is ready to turn down your legitimate case.

The answers are there. You just have to know how to look for them.

Whether the surgery is done by a neurosurgeon or an orthopedic surgeon, in the modern operating room there will be technicians who are doing intraoperative monitoring of your nervous system. After you are asleep, the technician will place electrodes on your scalp, arms and legs. All of the electrodes are hooked up to a computer, which will record the events of the operation electronically.

Nerves function by sending electrical impulses. Sensory (touch, pain, position information) impulses are constantly being sent to the brain, and their input can be measured and localized. The technician can tell whether the impulses are coming from the right or left leg or the right or left arm. Therefore, the sensory recording being done by the technician and recorded in the computer can tell the surgeon in real time, whether there is any interference in the sensory nerves passing through the area of the operation and where that problem is. The surgeon would be informed by the technician.

Simultaneously, there are motor impulses going to the motor nerves. These are impulses that are sent from the brain to the muscles to make the muscles move. The surgeon can check how well these nerves are functioning or if they are being injured during the course of the operation. He does this by stimulating the particular nerve, and the technician can see the result on her computer by looking at the electrode attached to the specific muscle. If there has been reaction from the nerve and it becomes diminished or absent, the technician would inform the surgeon of the problem.

None of the electronic data from the monitoring is in your medical chart. Indeed, in many instances, the fact that there is monitoring during the operation may not be in the chart. However, there is always evidence that monitoring has been done.

We know that getting the chart is not enough, and the monitoring data has to be obtained as well. The data will tell us exactly when during the course of the operation the problem became known to the technician. That will tell us what the surgeon was doing at the time the neurological problems arose.

In a step-by-step process, we know that there is a problem, what is the nature of the problem, when it occurred during the surgery and what the surgeon was doing, so we can then prove that what was done was done negligently.

If you or your attorney want to have a better understanding of intraoperative monitoring, call us. We will be glad to be of assistance.