From the 1Department of Orthopaedic Surgery at the University of California Davis Health in Sacramento, California, and 2Hospital for Special Surgery and Weill Cornell Medical College in New York City, New York.
PHYSICIAN HEALTH
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Second Victim Syndrome and Spine Surgeons:
The Hidden Complication We Rarely Discuss Safdar N. Khan, MD
Spine surger y is uniquely rewarding. It restores function, relieves pain, prevents neurological decline, and occasionally saves lives. Yet, every spine surgeon eventually encounters an adverse event that remains vividly etched in memor y long after the patient has left the hospital. A postoperative neurological deficit, an implant malposition, a vascular injury, an unexpected paralysis, a pseudarthrosis, or even a technically flawless procedure followed by an unforeseen complication can profoundly affect the operating surgeon. W hile much attention is appropriately focused on the patient—the primary victim of an adverse outcome—far less attention is directed toward the surgeon. The concept of the “second victim,” first described by Wu in 2000,1 recognizes that healthcare professionals involved in adverse patient events frequently experience guilt, shame, anxiety, self-doubt, and emotional distress. These reactions may persist for months or years and can influence future clinical decision-making, professional satisfaction, and personal well-being. Although second victim syndrome (SVS) has been increasingly recognized across medicine, it is particularly relevant to spine surgery, where technical complexity, high
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patient expectations, and potentially devastating complications create a fertile environment for ps ycholog ica l i nju r y a mong surgeons.
Todd J. Albert, MD
Why Spine Surgeons Are Vulnerable Several characteristics of spine surger y place practitioners at elevated risk for experiencing SVS. First, spine surgery carries substantial stakes. Few specialties possess the capacity to improve or worsen neurological function so dramatically. Even rare complications may result in lifelong disability, making adverse outcomes emotionally difficult for surgeons to process. Second, spine surgeons often develop long-standing relationships with patients. Unlike trauma or emergency procedures where interactions may be brief, elective spine surgery frequently involves months of consultation, imaging review, shared decision-making, and postoperative follow-up. W hen complications occur, the surgeon often feels a personal sense of responsibility that extends beyond the technical aspects of the operation. Third, t he culture of surger y historica lly rewards perfect ionism. Surgeons
Vertebral Columns Summer 2026