Two reasons why a headache is a red flag symptom after lumbosacral spine surgery

I’m in the middle of a pre-suit investigation of a medical malpractice case involving a spine surgeon and a major hospital in Houston’s Texas Medical Center.

My client is a man who enjoyed an active lifestyle of working on his farm, going on family vacations, and woodworking. As with many other people who reach the middle-age mark, he started experiencing some chronic lower back pain. He went to see a surgeon, who diagnosed him with spondylosis and recommended a multi-level spinal fusion surgery for vertebrae L5 to S1.

After the surgery was complete, the surgeon visited with the family and told them that the drill flipped and punctured the patient’s dura. The surgeon was referring to the dura mater, a protective layer surrounding the spinal cord and nerve roots. When the dura mater is accidentally punctured during surgery, it’s referred to as an incidental durotomy.

From my experience as a Houston, Texas medical malpractice attorney, I know that spine surgery experts believe that, most of the time, accidentally puncturing, nicking, or cutting the dura mater isn’t negligent, in and of itself. Medical studies reflect that about 5.1% of patients having a thoracic or lumbar surgery experience an incidental durotomy. The question is whether the surgeon recognizes this complication and then addresses it properly.

In my client’s case, the surgeon recognized the incidental durotomy and attempted to repair it. According to the family, the surgeon told the patient that he didn’t think the repair was successful, though, and the patient would have to lie completely flat for the next 48 hours, so his body could repair itself.

Big risks following punctured dura

If the surgeon doesn’t repair the incidental durotomy, the patient has a higher risk of having a leak of cerebrospinal fluid (CSF).

Specialists who’ve studied dural and CSF leakage have shown that patients are in jeopardy of having serious additional complications, including intercerebellar hemorrhage, or a subdural or extradural hematoma. All of these conditions can compress the spinal cord or nerve roots. Untreated spinal cord or nerve root compression can lead to permanent neurological impairments.

Surgeons treating patients who have experienced a dural tear must order the nurses to carefully monitor them after surgery. The most important thing to look for is any central neurological effect or unusual headache—one medical author describes either of them as an alarm signal. In fact, the author went even further, writing that any manifest complication requires an immediate return to surgery, without even waiting for a CT, MRI, or other type of diagnostic radiology imaging.

Stroke risk following spinal surgery

Even beyond the specific increased risk following a punctured dura, surgeons and nurses caring for patients who have had a laminectomy or lumbar spinal fusion must keep an eye out for signs of a hemorrhagic stroke.

The typical symptoms of a hemorrhagic stroke after spine surgery include headache, vomiting, a disturbance of consciousness, and mental disorder.

What happened to my client?

Shortly after my client got to the recovery room, the nurses started repeatedly noting that he was complaining of pain in his back and head. While back pain is expected after spinal surgery, a bad headache is unusual. The nurses didn’t notify the surgeon, who said he was kept in the dark. Family members recall that the patient was having a problem forming words and communicating, another classic stroke sign. Although the nurses noticed this, they also didn’t tell the surgeon about it.

The next day, the nurses noted that he had weak motor function in both of his lower extremities. This unusual finding is also consistent with spinal cord compression, but the nurses didn’t notify the surgeon or any other physician.

Eventually, the surgeon and medical team realized something was wrong and started ordering all kinds of imaging and tests to try to figure it out. Unfortunately, by then it was too late to take my client back to surgery to decompress his spine and nerve roots, which would have alleviated his symptoms.

Because of the delayed recognition of a problem by the nurses and surgeon—despite the added risk of a lumbosacral surgery and a durotomy—our client hasn’t been able to return to work, has difficulty speaking and forming the proper words, and has a hard time thinking clearly.

We are here to help

If you or a loved one has been seriously injured by hospital or medical care, then the experienced medical malpractice attorneys at Painter Law Firm, in Houston, Texas, are here to help. Click here to send us a confidential email via our “Contact Us” form or call us at 281-580-8800.

All consultations are free and, because we only represent clients on a contingency fee, you will owe us nothing unless we win your case. We handle cases in the Houston area and all over Texas. We are currently working on medical malpractice lawsuits in Houston, The Woodlands, Sugar Land, Conroe, Dallas, Austin, San Antonio, Corpus Christi, Bryan/College Station, and Waco.


Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. A member of the board of directors of the Houston Bar Association, he was honored, in 2018, by H Texas as one of Houston’s top lawyers. In May 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.

Robert Painter
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Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.