1) Lumbar spinal fusion, nerve irritation caused by a fixation screw

A patient underwent L4-5 lumbar spinal fusion due to degenerated disk and hypermobility of the spine. The procedure was otherwise successful, but the patient had pain and irritation in the lower left limb after the operation. Examinations indicated that the left fixation screw of the lower fixed vertebra ("pedicle screw") was partly located in the nerve root canal, irritating the nerve. The left fixation screws were repositioned in the resurgery, resulting in the irritation of the lower limb gradually disappearing.

The lumbar spinal fusion was medically indicated to treat the degenerated disk and hypermobility of the spine. However, the level of professional competence for a healthcare professional performing spinal fusions was not achieved with regard to one fixation screw. The screw extending into the root canal outside the bone could have been avoided by using a more careful operation technique.

The patient was compensated for personal injury caused by the nerve irritation and resurgery.

2) Surgical treatment of spinal stenosis and delayed treatment of haematoma

A patient underwent decompressive surgery of L3-5 for lumbar spinal stenosis. After the operation, the patient was in more pain than normal. In the recovery room phase, the patient reported feelings of numbness in both lower extremities. The motion of the lower limb weakened the following day and the patient could not urinate normally. The sensory disorder increased during follow-up, and the patient was in pain. The situation was monitored, and a decision was made three days later to take new MRI scans and urgent resurgery. Abundant haematoma was found in the operated site and removed. However, the haematoma had already compressed the nerves so that the lower limbs did not fully recover.

The spinal decompressive surgery was medically indicated to treat the spinal stenosis. Surgical treatment always involves the risk of haematoma, and it cannot be always avoided in spite of the appropriate implementation of the procedure. However, the symptoms of numbness in the lower limb, abnormal pain, weakness of the lower limb and urination problems experienced by the patient should have been reacted to faster, deciding on resurgery earlier. This way, the symptoms of paresis in the lower limb could either have been completely avoided or they could have remained slighter. It was estimated that the required level of professional competence in health care was not reached in the post-operative follow-up and evaluation of the need for resurgery. An emergency MRI scan would have been justified 2 days earlier.

The patient was compensated for personal injury caused by the lower limb nerve problems. On the other hand, the resurgery would have been necessary to treat the haematoma in any case, so the resurgery was not compensated for under patient insurance.

3) Spinal disk hernia operation on the wrong disk space

A patient underwent a thoracic spine disk hernia operation on disk space 6-7. After the operation, difficulties walking returned and the previous symptoms exacerbated. A more detailed radiographic examination was performed on the patient, indicating that the operation had been performed on disk space 5-6. The exacerbation of symptoms was successfully stopped with a resurgery on the right disk.

The patient's surgical treatment for disk herniation was medically indicated for the treatment of the degenerative disk disease. The operated space was probably marked incorrectly before the operation. Even though the pinpointing of vertebrae in the thoracic spine region is demanding, it would probably have been possible to reach the correct level by acting more carefully, making it possible to avoid the resurgery and continued symptoms.

The level of professional competence for a healthcare professional performing intervertebral disk hernia surgeries was not achieved in the operation, so the patient was compensated for temporary incapacity caused by the extraordinary surgical procedure.

4) New intervertebral disk hernia soon after surgery

A patient was operated on due to a lumbar intervertebral disk hernia. At first, the outcome of the operation was good. Later, the patient's back became sore again. A new protrusion was found in new examinations in the intervertebral disk space that had been operated on.

The surgery for the intervertebral disk hernia was medically justified and technically it was performed in an appropriate way. Intervertebral disk hernias can recur and cause symptoms, and this cannot be avoided through treatment procedures.

The case did not meet the criteria for an injury compensable under the Patient Injuries Act.

5) Surgical treatment of spinal stenosis, breaking of screws and non-ossification

A patient underwent surgical treatment for spinal stenosis. After the operation, it was found that the screws used for fixation had broken and the fixation point had not ossified as desired. The operation had to be repeated.

The treatment of the spinal canal through ossification was medically indicated. Based on the X-ray images available, it could be estimated that the technical implementation of the surgery had been appropriate.

The breaking of the fixation screw and slowed ossification could not be avoided in spite of the appropriate implementation of the procedure.

The case did not meet the criteria for an injury compensable under the Patient Injuries Act.

15.06.2016