Allegation:
Plaintiff Alleged Pain, Suffering, and Negligent Performance of Cervical Fusion in Surgery.
The Case:
The patient, a 45 YOWM (5'8", 214 lbs.), presented to his PCP with complaints of right shoulder pain radiating into the entire right arm. An EMG revealed bilateral peripheral neuropathies in the upper extremities. The MRI revealed C5-6 and C6-7 paracervical/foraminal disc herniations with right foraminal narrowing creating potential sources of impingement.
About two months later, the patient was referred to the defendant neurosurgeon who reviewed the MRI and ordered physical therapy (PT). After two more months, the patient saw the defendant neurosurgeon since PT had failed to alleviate his pain. The recommendation was for the patient to have a surgical repair of the disc herniation. The defendant neurosurgeon performed a microscopic anterior cervical discectomy and fusion (ACDF) of C5-6 and C6-7 with bone bank allografts and anterior cervical ZEPHIR™ plating hardware. The procedure was without complications and the patient was discharged the next day.
The defendant neurosurgeon documented complete resolution of the right arm pain and paresthesia, but noted that left shoulder discomfort radiating to the left arm remained. The defendant neurosurgeon prescribed PT and a Medrol Dosepak. Two months later, the defendant neurosurgeon noted that the RUE pain and paresthesia had completely resolved.
About two months afterward, the PCP documented right neck and arm pain increasing for two days. The pain was noted, "to feel exactly as previous when he had a herniated disc." An MRI revealed residual right foraminal stenosis at C5-6 due to bony uncinate hypertrophic foraminal spurring. The defendant neurosurgeon reviewed the findings with the patient two weeks later, and noted some very mild narrowing of the root on the right side. He did not believe surgery was required. Six months later, the PCP documented that the patient’s numbness and radicular pain had resolved.
One year after last being seen by the defendant neurosurgeon, the patient contacted the defendant with complaints of limb and neck pain. An MRI was ordered along with PT due to continued cervical pain. The defendant neurosurgeon also noted that the patient's RUE symptoms had resolved. The patient attended PT until his pain decreased from 7/10 to 4/10. One month later, the patient presented to the defendant neurosurgeon with complaints of new pain between his shoulder blades for a year. Chiropractic care was recommended.
The patient returned to the defendant neurosurgeon the following year. He reported his right arm pain had totally resolved, but he continued to experience pain between his shoulder blades and new left ulnar neuropathy-type symptoms. The defendant neurosurgeon continued to order PT and prescribed Motrin® three times a day as needed. Later that year, the patient saw his PCP, who noted a herniated disc with left 4/5 fingers numbness; the patient reported the pain was the same. Over the next few years, the patient continued to have chronic neck pain but was not taking any medication; he did not want any further treatment.
Over four years later when the patient returned to the defendant neurosurgeon, an MRI was ordered to assess neck pain that radiated into the upper back. The MRI revealed that the craniocervical junction, atlantoaxial region, and C2-3 and C3-4 disc spaces/foramina remained generally unremarkable; mild facet arthrosis was present at C2-3 and C3-4; C4-5 disc space exhibited some minimal central bulging, but no spinal cord compression; C5-6 had minimal foraminal compromise due to uncovertebral joint hypertrophy and spurring were noted on the right; Mild stenosis was also present at C6-7 on the right. The impression noted little change in effect on the spinal canal since the last study, but increased hypertrophic changes at C4-5 anteriorly. The patient refused a physical medicine and rehabilitation consultation recommended by the neurosurgeon.
The following year, the patient's symptoms returned and worsened; he sought a second opinion from an orthopaedic surgeon. The surgeon determined there may be a loose screw and plate overriding at C4-5. He performed an ACDF at C4-5 using VG2® allograft on February 19, 2013, with removal of the plate and screws. The operative report notes: "I dissected the soft tissue overlying the plate free and was able to easily identify the loose screw on the left at C5. This was removed with the use of pick-ups; there was no significant purchase whatsoever in the vertebral body. I then proceeded to remove the remaining three screws without difficulty. I cleared the soft tissue overlying the vertebral bodies and confirmed evidence of solid arthrodesis from C5-7. I used the burr to remove the large anterior osteophyte overlying the C4-5 disk space and caudal portion of the C4 vertebral body."
The patient started receiving steroid injections nine months after the second surgery. He did not return to work and suffered from depression.
Plaintiff alleged pain, suffering, and negligent performance of cervical fusion in the first surgery, necessitating surgical revision and additional fusion eight years later. The plaintiff’s experts testified the misdiagnosis and misreading of the images caused the need for a subsequent revision surgery. They also attributed the pain the patient experienced between the surgeries to negligence. The overriding of the cervical plate at C4-C5 disc and the screws traversing the C4-C5 disc space contributed to degeneration of the adjacent cervical disc at C4-C5, necessitating the additional anterior cervical discectomy and fusion of C4-C5.
Defense experts stated the neurosurgeon met the standard of care. They acknowledged there was a space between the plate and the anterior spine seen on the MRI, but considered it benign. When comparing the MRIs and the CT scan, it was noted the cervical plate may have been pulling away and subsiding. Subsidence is a risk of this procedure; the presence of any subsidence in this case was not an indication for another operation to remove the hardware.
Verdict:
The jury agreed with the defense expert’s testimony. They returned a defense verdict since the complication was a known risk of spinal surgery.
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