Spinal Fracture - Second Opinion - Medical Advice

[chaplinchandler]

MEDICAL ADVICE FROM A PROFESSIONAL WOULD BE MUCH APPRECIATED

My daughter (33F) is currently in hospital in the UK with a fractured back. This injury was incurred six days ago, after falling about 2.5 metres from a window onto a skylight. It might also be worth mentioning that she has hypothyroidism, which affects bone density.

The hospital where she is currently staying wish to perform an operation, which involves installing a rod. However, my daughter doesn’t wish for an operation, not without a second opinion from outside the hospital. At present, she is prepared to recover by resting her back.

According to the spinal surgeon, she has fractured the lumbar bone L4, and a nerve has been compromised. Below is a photo of the imaging provided by the doctor. The doctors want to push ahead with the operation. According to them, extra pressure on the nerve could result in paralysis. However, they are also worried about the legal side of things, and respecting the patient’s wishes.

Based on the imaging, and the situation described, do you think the hospital’s concerns are justified? Do you think surgery is required? And do you think a second opinion is strongly advised?

imgur.com/a/71Qb5V2

is she from the uk?

ime the nhs is shit when it comes to second opinions.
not sure if a private consultant could examine in an nhs hospital. private review of images is expensive.

first point of call would be her consultant or possibly the pals of the hospital.

good luck and all the best to your daughter

Yes that injury could result In paralysis

@chaplinchandler I'm not a health professional but I have osteoporosis and hypothyroidism having recovered from hyperthyroidism in my late 20s. Now 61.

I have wedge fractures to my L1 and T12. No compromise of any nerves and tbf I have had to fight like Billyo for optimum treatment for the osteoporosis. And maximise any future mitigations in relation to the future.

IF THE NHS ARE RECOMMENDING SURGERY CONSENT WITHOUT HESITATION. Although I might request it is carried out by the Hospital's spinal consultant and not the registrar.

I’m no expert in spinal injuries but I have had a spinal fracture. Complete fracture of L1, mine did not need surgery. I can’t imagine why the nhs would be advising surgery if they felt it wasn’t needed. I do know that resting will not sort out every spinal injury and I would listen very carefully if they are saying the nerve compression could result in paralysis. From my non expert experience of seeing loads of my own spinal x-rays I’d say that looks like significant compression.

I think the chances of getting an out of hospital opinion would be difficult. No other consultant from another hospital is going to come and see her. I’d assume her leaving the hospital would be dangerous. She could ask for an opinion from another consultant in that hospital. Just because they are colleagues please don’t assume the second one would agree with the first one just to back him up. I’ve worked for the nhs for some time and it doesnt work like that, if the second consultant thinks the first one is wrong they will say so.

you can also google the consultants and see how much orthopedic spinal experience they have.

Your poor daughter.

I'm a physio and have worked in spinal settings. Personally my opinion (based on the info you've given and the image) is that that injury could cause significant nerve damage and an operation would be indicated.

Why is she hesitant about an operation? Which hospital is she at?

What is she worried about? Why is she saying no?

I've also worked with spinal patients. She really needs that op. If she's in a hospital with a spinal service she could ask for a a second opinion, but I wouldn't risk transfer to another centre, possibly a very long distance away for someone else to say the same.

As a PP said, nerve compression is a big problem and also can be very painful. They won't do spinal surgery unless it's absolutely needed.

@chaplinchandler This might be a big help to you and your daughter, to understand why it’s so clear to everyone that she is at risk of paralysis. I’ve attached a normal image of the same section of the spine, right next to the image of your daughter’s. As you can see, that “white area” where the nerve is in the spine, should be completely clear. Yet in your daughter’s image, it’s almost completely “covered” by the broken bone. This is why they feel the bone is compressing the nerve, and the risk of paralysis is so high. While I can’t say it with 100% certainty, I think it very, very likely that any doctor would recommend some kind of surgery. Is your daughter afraid of surgery? I can completely understand that, but perhaps she’s not understanding the risk of paralysis. The compression seems fairly severe and it’s very easily seen in the image.

@chaplinchandler I also absolutely recommend, if your daughter is still scared/unsure, maybe even asking the doctors to show her a normal image in comparison to hers so she can see what their concerns are and why they recommend surgery and fear paralysis.

Also does she realise that the longer she leaves it the more damaged the nerve will be from the compression and that nerve damage may not be reversible even with surgery.

friend of mine had a spinal injury (not fracture) which involved nerve compression. She needed surgery but was kept waiting a week for it as they were so busy. She spent years walking with a stick, as far as I know she still has no bladder control and has to catherterise and also has to manually evacuate her bowel as she can’t poo.

Does your daughter want a second opinion or has she already made her mind up that she is refusing surgery and you’re hoping for the second opinion? What are her reasons for refusing the surgery? Resting her back isn’t going to fix this problem, where or how has she come to the conclusion that this is an option?

How thoroughly have the doctors explored the options with her? Is she open and amenable to discussion? Have her concerns been properly addressed? Is she generally suspicious/distrustful of the medical profession? Perhaps into holistics and alternative therapies? Or is there some very specific concern she has about this particular option or the competence of the surgeons? Is she mentally well?

What type of hospital is she in? Is it a local small district general or has she already been transferred to a specialist spinal unit?

Sorry, lots of questions, but seeking a second opinion may not achieve anything unless there’s a very specific concern about the surgery or the type of injury that can be adequately addressed. If the issue is with her health beliefs (perfectly entitled to have differing beliefs or distrust in the biomedical model) and trust in the profession/system then she’ll likely just dismiss the next persons opinion too.

Where the arrow is, you can see mine. I had cauda equina and had immediate surgery after this MRI as they said there was a massive risk of paralysis. I still have nerve damage

Helps if I attach it...

Your daughter presumably is in an NHS specialist centre with more than one spinal surgeon - so she can have a second opinion from someone at her hospital.

Not being able to move it is tricky for her to been seen by someone else. Why has she decided that someone outside the hospital will be more skilled that the professionals inside the hospital? The NHS entitles you to a second opinion but it does not pay for someone from a neighbouring trust to cancel their clinics/theatre lists and come over to see someone in the hospital 50 miles down the road because they aren't liking the advice they are given.

She should be made aware that decisions nowadays are very much a team game - deciding the best route for her is surgery won't have been made by one surgeon by him/herself but the surgeon, the radiologist, the neurologist and probably all the other surgeons together in a multi-disciplinary meeting where her case was discussed. It may even have involved video links with other specialists at other hospitals.

Also the longer she delays, the more pressure she puts on her nerve. Rest is not going to get that bone off her spinal cord. Her scan is a horror show.

I'm stunned that your daughter imagines that resting will fix this. It's not just 'a' nerve that is being compressed but 'the' nerve bundle that supplies feeling and movement to her legs, bowels, bladder, sexual organs. She is at serious risk of paralysis and loss of function in these areas.

I have permanent nerve damage in one leg from a herniated disc, which is much less severe than your daughter's injury.

OP is this perhaps a case of inadequate detail and information health professionals who have told her this is what we need to do without the why?

She's probably extremely scared, can you visit her OP?

Not sure why you would take advice from a stranger on the internet when a specialist MDT will have discussed your daughters injury and recommended the best course of action?

yes surgery is indicated from the scan.

why does she not want surgery?
has something happened to make her distrust the team she’s under?

@chaplinchandler hope you and your Dd are both doing ok.

Do hope you and your daughter are doing okay. I had a spinal fracture to C6 and 7 and subsequent surgery about 7 years ago. I remember how scary it was but I made a full recovery and returned to a normal, active life. I did need to have the operation as my fracture was unstable. Is there a specialist nurse or physio she can discuss it all with - sometimes they can be very helpful, reassuring and practical. Wishing you both well.

Where exactly is your daughter planning to “rest her back” At home ? Do you have a hospital bed, a hoist, a laundry service, enough people trained in moving patients with spinal injury, physios on hand, the ability to monitor and administer pain relief?

Or is she planning on bed blocking an NHS bed until several weeks or months down the road she is realises that her spine is not healing and yes please, she will have the operation, the physio and the aftercare that was previously on offer.

I am not a doctor but I cannot imagine a situation where I was in a UK hospital with a fractured spine, a spinal consultant telling me I needed surgery to avoid paralysis and I decided they were mistaken and it would be ok if I just rested instead.

Do you think the hospital’s concerns are justified? Do you think surgery is required?

Yes. The spinal surgeon thinks it is required. That's all she needs to know. The NHS do not perform unnecessary and expensive operations for the sheer fun of it.

Tell her to stop being so silly and listen to what the experts are telling her.

OP.

Please ignore the comments stating that surgery is, or isn't required. Nobody here knows because nobody here has examined your daughter, nobody has seen the whole scan, you haven't provided any information on her clinical status, and nobody has any details about her past medical history to make an informed judgement about the risks and benefits of surgery in her case.

The surgeons who have seen her have.

Spinal surgery is particularly specialised, not all units, or even all cities will have a spinal service, a second opinion from outside the unit may be difficult to obtain.

DOI: orthopaedic surgeon with interests in trauma, major trauma and foot surgery, I see and manage injuries like thi on an almost daily basis.

No expertise OP but when they discharged DS from hospital 2 weeks ago they gave him a hard copy of all his notes from his hospital stay.
THERE WERE THREE OCCASIONS WHERE DOCTORS FROM OTHER DISCIPLINES HAD TO SAY WHETHER OR NOT THEY AGREED. They partially agreed, partially disagreed and where they disagreed they jolly well said so. you might be able to persuade her to look at those notes as they stand to date and they might illustrate the team-based discussions that others have referred to.

Good luck, you must be going out of your mind as a mum x