This case involves a fifty-two-year-old patient who underwent an L5- S1 discectomy and fusion procedure that was met with significant complications. The patient required a revision procedure two weeks after the original surgical intervention. It was determined that a screw was left behind at the L5 which caused foot drop and other neurological deficits that resulted in the patient no longer being able to walk without assistance.
Outcome after fusion surgery is measured in terms of the three cardinal clinical manifestations of spinal instability: neurological function, pain, and disabling deformity. With overt instability (trauma, tumor, infection, etc.), neurological function after surgery is directly related to preoperative neurological status and cannot be used as a measure of success of fusion surgery. For instance, after a thoracolumbar fracture-dislocation with cord laceration and paraplegia, the success of fusion surgery should not be measured in terms of recovery of neurological function, but in terms of addressing disabling deformity and pain. The screw being left behind would definitely be a breach in care and the only way to prevent this is meticulous disection during the entire procedure to ensure no instruments or materials are left behind.
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