Interval Post Operative Retention of Key Portions of the Informed Consent Discussion in the Adult Deformity Patient IRB Approval Date:

For spinal deformity patients who have agreed to participate in the informed consent study

 This video is for research purposes only.  It does not take the place of a consent form.  The complications listed are the more common complications but this is not included every complications you might experience.  Please talk to your physician if you have any questions.  Please talk to your physician if you have questions about this video or the risks discussed or any additional questions about this procedure.

 How important do you think the informed consent process is on a scale of 1-10 with 10 being most important? 

 Infection (2-5%)  Inadequate pain relieve or new pain (5-20%)  Need for more surgery (15-25%)  Medical complications (10-20%)  Weakness (5-10%)  Skin or muscle or nerve positioning complication (2-5%)  Instrumentation malposition (.5-20%)  CSF leak (2-10%)  Bleeding that requires transfusion (50-75%)  Death (.5-2%)  Blindness ( less than 1%)

Rate 2-5%

(5-20%)

(15-25%)

(10-20%)

(Approx 5-10%)

(2-5%)

(.5-20%)

(2-10%)

(50-75%)

( less than 1%)

(.5-2%)

 Infection (2-5%)  Inadequate pain relieve or new pain (5-20%)  Need for more surgery (15-25%)  Medical complications (10-20%)  Weakness (5-10%)  Skin or muscle or nerve positioning complication (2-5%)  Instrumentation malposition (.5-20%)  CSF leak (2-10%)  Bleeding that requires transfusion (50-75%)  Death (.5-2%)  Blindness ( less than 1%)

 How well informed do you feel now after the consent process on a scale of 1-10 with 10 being very well informed and 1 being not well informed at all? 

 How important do you think the informed consent process is on a scale of 1-10 with 10 being most important? 

 How much did the slide show help on a scale of 1-10 with 10 being most helpful and 1 not helpful at all? 

 What do you think is your risk of experiencing one of these complications?  0%  10%  20%  30%  40%  50%  60%  70%  80%  90%  100%

 11 possible risks of my surgery are:  _____________________

 Recall common or uncommon  Is this a major or minor complication

 Common  Rare  1 Minor  2  3  4  5  6  7  8  9  10 Very severe

 Common  Rare  1 Minor  2  3  4  5  6  7  8  9  10 Very severe

 Common  Rare  1 Minor  2  3  4  5  6  7  8  9  10 Very severe

 Common  Rare  1 Minor  2  3  4  5  6  7  8  9  10 Very severe

 Common  Rare  1 Minor  2  3  4  5  6  7  8  9  10 Very severe

 Common  Rare  1 Minor  2  3  4  5  6  7  8  9  10 Very severe

 Common  Rare  1 Minor  2  3  4  5  6  7  8  9  10 Very severe

 Common  Rare  1 Minor  2  3  4  5  6  7  8  9  10 Very severe

 Common  Rare  1 Minor  2  3  4  5  6  7  8  9  10 Very severe

 Common  Rare  1 Minor  2  3  4  5  6  7  8  9  10 Very severe

 Common  Rare  1 Minor  2  3  4  5  6  7  8  9  10 Very severe

 Infection (2-5%)  Inadequate pain relieve or new pain (5-20%)  Need for more surgery (15-25%)  Medical complications (10-20%)  Weakness (5-10%)  Skin or muscle or nerve positioning complication (2-5%)  Instrumentation malposition (.5-20%)  CSF leak (2-10%)  Bleeding that requires transfusion (50-75%)  Death (.5-2%)  Blindness ( less than 1%)

 This video is for research purposes only.  It does not take the place of a consent form.  The complications listed are the more common complications but this is not included every complications you might experience.  Please talk to your physician if you have any questions.  Please talk to your physician if you have questions about this video or the risks discussed or any additional questions about this procedure.