Allegation:
The defendant neurosurgeon negligently performed a cervical discectomy and fusion that led to several corrective surgeries for the patient .
The Case:
A 63 YOF (5’9”, 185 lbs.) presented to the defendant neurosurgeon with a complaint of neck and left arm pain. The patient described the character of her pain as an achy, sharp pain which had worsened over the prior six months. She had exhausted nonsurgical remedies including physical therapy, epidurals, steroid injections, chiropractic care, and medications without significant relief.
An MRI of the cervical spine revealed cervical spondylosis with posterior bony spurring and bulging disc, most prominent at C4-5 and C6-7. The EMG nerve conduction studies showed bilateral carpal tunnel syndrome and left sensory median compressive neuropathy across the cubital tunnel. The patient's medical history was significant for diabetes with polyneuropathy, HTN, thyroid disorder, ulcers, gastritis, joint pain, joint stiffness, and weight gain.
The defendant neurosurgeon performed an anterior cervical discectomy and fusion at C4-5 and C6-7, left endoscopic carpal tunnel release, and left cubital tunnel release. Fluoroscopy was used to confirm the C4-5 and C6-7 levels. The disc space was incised and disc material removed at C4-5 and C6-7; cervical plates were then attached. No bleeding from soft tissues or the epidural space was reported. DuraGen® was placed to help reinforce the patient's weak, thin dura. The defendant then turned to the left upper extremity and applied a tourniquet to complete surgery on the left upper extremity.
A scalpel was used to make a transverse skin incision medial to the palmaris longus tendon and at 1 cm proximal to the wrist crease. After the skin was closed, the defendant proceeded to the left elbow and bluntly dissected and identified the ulnar nerve. The nerve was well decompressed into the forearm, and the cubital tunnel fascia was subsequently opened up. After closure, the defendant reported minimal blood loss. The patient tolerated the procedures well and was taken to the recovery room in stable condition. She was discharged the following day.
Three days later, the patient returned to the ED due to trouble swallowing and respiratory issues. The partner of the defendant neurosurgeon saw the patient and reported the symptoms were most likely due to a hematoma. The partner recommended operative intervention. Under general anesthesia, the hematoma was located and evacuated, and the partner surgeon inserted a drain. The patient seemed to be doing well for several days until she developed a collection in her cervical prevertebral space and subcutaneous space consistent with a pseudomeningocele.
The defendant’s partner was of the opinion that placement of a lumboperitoneal shunt was the least likely procedure to expose the patient to infection. Options were discussed with the patient and her son; all questions were answered and informed consent was obtained. After the procedure, the patient's neck pain was resolved; however, the patient continued to have left elbow and hand pain.
The plaintiff sued alleging the defendant neurosurgeon lacerated the dura mater during the cervical surgery, failed to document the injury, and failed to inform the patient or document this complication in the record. The plaintiff also alleged the defendant used DuraGen® to cover-up his "mistake" and that he may have used a bone morphogenetic protein (BMP) implant, which is contraindicated in the cervical region.
The patient’s subsequent neurologist testified that the patient’s exam was essentially normal one year following surgery except for the fact she had a shunt in place. The subsequent neurologist found no spasms and no abnormal objective findings. There was no weakness in the patient’s neck extensors or flexors, and she had full range of motion in her neck. She also had a normal neurological exam and a normal CT scan, other than the hardware and some degenerative changes.
The defense countered that if there had been a dura tear, the defendant would have used DuraSeal®. Documentation clearly shows that a BMP implant was not used. The defendant stated that he had a lengthy conversation with the patient in which he described the risks, benefits, and complications involved with performing surgery. The patient had verbalized understanding of the potential risks, signed the consent, and wanted to proceed with the surgery. A defense expert stated the patient's postoperative symptoms and conditions were a result of known risks of the cervical fusion, and any patient undergoing these types of surgeries could expect these risks.
Verdict:
The case went to trial, and the jury returned a unanimous defense verdict.
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