ALL medical procedures carry serious risks and with spinal surgery they can be particularly grave.

Nerve damage and paralysis are among those listed on official NHS websites, and while most people find operations relieve their back or leg problem, success is not guaranteed.

Adrian Casey, president of the British Association of Spine Surgeons, said there had been dramatic advances in the field in the last 10 years. He said: "We want patients to get better. That is our main agenda, but some patients are unlucky."

He explained that no matter how careful the surgeon, screws sometimes will not go where intended. Orthopaedic surgeons, as well as neurosurgeons, carry out spinal surgery. Some orthopaedic consultants exclusively focus on backs, but some will also take on other areas of orthopaedic work such as hip and knee replacement operations.

For some years there has been a system in place in Scotland to monitor the outcomes of joint replacements, known as the Scottish Arthroplasty Register or Project. This scrutinises the complication rates of surgeons and notifies consultants if their rates are unusually high and invites them to submit more information about their cases to see if there is room for improvement. Often there are reason-able explanations.

It was this system which the chairman of the Scottish Committee for Orthopaedics and Trauma referred to when he wrote to BMI Ross Hall Hospital in Glasgow in 2005 asking them if "arrangements for audit and clinical governance of total joint replacements is as robust as that currently in place within the wider NHS sector".

Colin Howie, vice-president elect of the British Orthopaedic Association and previous leader of the arthroplasty project, said Ross Hall had responded.

But he said: "There is really no evidence of them taking any action and this is disappointing.

"There are many excellent surgeons working in the private sector and at Ross Hall and their patients receive excellent standards of care. These surgeons participate in national audits and those that also work in the NHS are automatically part of the governance process."

In a statement, BMI Healthcare said: "BMI Ross Hall Hospital, and all other independent hospitals in Scotland, have always proactively sought to contribute to the voluntary Scottish Arthroplasty Register (SAR) and for many years submitted data to the NHS Information Service Division (ISD), which collates the data, in a paper format.

"From 2006/7 the ISD ceased to accept paper submissions. Instead a pilot scheme was launched at another independent hospital but this has not been rolled out across Scotland. Therefore although very willing to provide this data, BMI Ross Hall is prevented from doing so."

A national system for auditing the work of spine surgeons across the UK has been developed and participation is voluntary.

However, Mr Casey said in the NHS, where orthopaedic surgeons work in a team, it was usual for checks to be in place –such as staff presenting results to colleagues on a regular basis.

Mr Mainds worked purely for the private sector from 2005. He admitted before the Medical Practitioners Tribunal Service hearing that by 2009 he was frequently working seven days a week.

Defending, Christina Lambert, QC, told the panel Dr Mainds' practice "spiralled out of control" as he took on up to 600 new patients in a year.

Mr Howie said: "Working for prolonged periods of time seven days a week causes stress and tiredness and that tiredness can lead to poor outcomes.

"This is highlighted and dealt with through the European Working Time Directive." BMI Healthcare said as consultants in their hospitals were "self-employed practitioners", their centres "do not have legal obligations under the working time directive" with regard to their hours.

They continued: "However, our hospital executive directors would always intervene should they consider a consultant to be working excessive hours.

"Mr Colin Campbell Mainds did not hold practising privileges at any BMI Healthcare hospital other than BMI Ross Hall. We can confirm Mr Mainds never worked excessive hours or seven days a week at Ross Hall Hospital; his caseload was always reasonable and manageable."

Mr Mainds' practising privileges which allowed him to work in Ross Hall were suspended in October 2009 and BMI Healthcare has made it clear he has not worked in a BMI hospital since that date.