Thank you for completing this form.

Please note that this form is not designed to frighten you or put you off surgery . It is very important that you are fully informed about the risks of any surgical procedure. Mr Akmal and the spinal unit have a very low complication rate and it is probably one of the reasons that you have been referred to our Spine Unit. All surgical procedures carry risks in the same way that driving a car for example carries risks regardless of how skilled the operator is.

Although Mr Akmal and his colleagues have a lot of experience in spinal surgery, it is very important that surgeons give their patients a fully informed consent.
It is also a requirement of Insurance companies and Regulators that surgeons inform patients of as many risks as possible before undertaking any surgery in order to provide insurance cover for them.

Please do not hesitate to speak to your GP or any of the spinal team doctors or nurses if you are unsure about any aspects of your treatment or wish to discuss other treatment options.

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1. It is important for you to understand the nature of your operative procedure, what to expect from your surgery and the risks which may occur with this operation and also rare but significant other complications which have been known to occur.
The main complications will be explained below, however, this is not an exhaustive and exclusive list and other unforeseen complications such as deep venous thrombosis, death and paralysis may occur.

Please confirm that you understand this and are agreeable to undertaking this informed consent process.
2. Pain often masks numbness and weakness.These symptoms may persist after surgery. It can take a long time for symptoms of numbness, weakness or back pain to improve.
In some cases there may be no improvement at all. Some patients will continue to experience nerve pain if the nerve compression has been going on for a prolonged period.

Please confirm that you are you aware that symptoms of Numbness, Weakness and Pain may not get better with surgery and may even worsen?
3. Back pain and sciatica can improve without surgery. Pain relief may be achieved with physical therapy, tablets or injections. We would always recommend trying simpler methods before surgery.

Please confirm that your doctor has explained and you have tried simpler methods to help control the pain such as physical therapy, painkillers and injections.
4. Infection affects around 2 out of every 100 patients treated (ie 1 to 2%) : this can be serious if the infection gets into your spine or settles in your disc space. If it occurs, you will need an intense course of antibiotics in hospital and may require further surgery.

Do you understand what the risk of infection is despite the use of routine antibiotics during surgery. Risk of infection ?
5. Bleeding affects less than one out of every 100 patients treated (less than 1%): very rarely this may include damage to the main blood vessel lying at the front of the spine (the aorta or Inferior Vena Cava) requiring emergency vascular surgery.
If you take medicines to thin your blood, there is an increase risk of an epidural haematoma (a localised collection of blood around your spinal nerves). This can cause complications, such as spinal cord and nerve compression which may require a further surgical procedure to evacuate the blood clot.
You may need to stop taking blood-thinning medicines before your operation. Please check with your GP to make sure it is safe to stop the blood thinning tablets.

Risk of Major bleeding during surgery ?
6. Spinal fluid (CSF) leak affects about 1 out of every 20 patients treated ( 5% ): occasionally the outer covering of your spinal cord (dura) may come apart causing leakage of spinal fluid (CSF). This is not serious but it can cause a dull headache for up to a week and you may need to lie flat for some days after the procedure. Spinal fluid leak may delay your discharge from Hospital and your recovery or may require further surgery if it does not heal naturally.

What is the risk of CSF leak in lumbar surgery ?
7. Spinal nerve injury affects around 1 out of every 100 patients treated ( 1% ): your nerve roots (nerves in the lower part of your spine) may be stretched, bruised or damaged as part of the procedure. This can lead to a loss of feeling or muscle weakness. In the worst case scenario a permanent weakness can occur. This is more common in revision surgery. Please note that nerve damage can also occur without treatment or delayed surgery.

What is the risk of Nerve injury during surgery ?
8. Cauda Equina injury affects around one out of every 1000 patients treated ( 0.1% ):  your cauda equina (nerves in the lower part of your spine travelling to bowel and bladder) may be stretched, bruised or damaged as part of the procedure. This can lead to a loss of feeling or muscle weakness resulting in bladder/bowel dysfunction. Rarely these symptoms can be permanent. Please note that Cauda Equina Syndrome (bowel and bladder nerve dysfunction) can occur in upto 2% of untreated disc prolapses without surgery.

What is the risk of Cauda equina injury during surgery ?
9. Recurrent back pain or leg pain occurs in approximately 5% of patients after surgery. This may occur immediately after surgery or in the future and maybe related to adjacent disc problems or implant related issues.

Are you aware that your condition may recur after surgery ?
10. There is an increased risk of complications in obese people. Complications such as Wound infection, chest infection, heart and lung complications, and thrombosis are more common.

Please confirm that you understand that risks are higher in obesity and that you are making every effort to lose weight prior to surgery.
11. Are you aware that you can cancel the surgery at any time and there is no obligation for you to proceed. You may also contact your doctor or the spine team for a further consultation if you are unsure about any aspect of the surgery.

If you proceed to surgery at short notice you have carefully considered other options and have discussed this with your doctor.
12. Are you aware that there are other rare unexpected complications that may occur with spinal or other forms of surgery requiring General Anaesthetic. Below is a list of rare complications.Please note that spine unit surgeons take the highest level of precautions to prevent these complications from occurring.

Please tick each box once you understand each item.
13. We have a standard insurance policy to cover legal and financial liabilities against malpractice (limited to £500k cover). If you require a higher rate of cover due to the nature of your profession (or any other reason) ie professional sportsman, celebrity or businessman, high net worth then it is your responsibility to ensure that extra cover is arranged prior to surgery. You must let us know before proceeding to surgery.
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