Acute traumatic spinal cord injury. Consent is a new cause of action

There are two management strategies for the early management of acute traumatic spinal cord injury (SCI); 10–12 weeks bed-rest or rapid mobilisation (typically following surgery to stabilise an unstable spinal column injury). A recent review has demonstrated poor outcomes with rapid mobilisation with up to 13.2% deteriorating neurologically (0% in one of the conservative series) and 24%–33% of cases failing to improve to walking (compared with the conservative cases). The Montgomery and McCulloch SC judgements mandate that the benefits, risks and alternatives to any proposed treatment are discussed with patients. Previously there was no duty of care to explain the risks and alternatives to rapid mobilisation. There is no decided case but in the light of current knowledge the inferiority of rapid mobilisation, and the alternative of conservative treatment with better outcomes should be explained to patients. A failure to do so could be negligent in respect of consent for treatment.