Virginia Lawyers Weekly//January 24, 2019
Virginia Lawyers Weekly//January 24, 2019//
Plaintiff underwent an anterior cervical discectomy, osteophytectomy and arthrodesis C3-4, C4-5 and C5-6 using intervertebral disc spacers and an anterior cervical plates extending from C3-C4 to C5-6. After finishing at C3-4, the defendant neurosurgeon turned his attention to the C4-5 level and he placed an intervertebral disc spacer and an 8 mm spacer without difficulty. Once the hardware was in position, the Motor Evoked Potentials (MEPs) were checked and the neuromonitoring technician reported that plaintiff no longer had MEPs.
This loss of MEPs coincided with a marked decrease in plaintiff’s intraoperative blood pressure and heart rate. After the anesthesiology team acted to improve plaintiff’s blood pressure and heart rate, her right-sided MEPs returned but her left side remained absent.
Defendant used intraoperative fluoroscopy to confirm that there was no movement of the instrumentation he had placed at C3-4 or C4-5. He then proceeded to the placement of a 7mm disc spacer at C5-6. Multiple trials of MEPs were carried out and there was return of the right side MEPs but not the left prior to completing the operation.
After the procedure, plaintiff was transferred to the PACU. She reported left-sided weakness and paralysis of her left upper and lower extremities. Defendant consulted a neurologist to work up defendant’s post-surgery neurologic deficits. Approximately 12 days following her surgery, plaintiff received an MRI which revealed compression on her cervical spine.
Plaintiff’s experts testified that the defendant’s treatment fell below the standard of care in multiple respects. Plaintiff contended that the defendant should have ordered an MRI of plaintiff’s spine immediately following her surgery. If this had been done defendant would have realized that the hemostatic agents used during the procedure were compressing on plaintiff’s spine and that defendant should have then immediately performed another surgery to relieve the compression. Plaintiff’s causation experts testified that it was the compression on plaintiff’s spine that was causing her injuries.
The defense conceded that the standard of care required the defendant to order a cervical spine MRI following the surgery. Notwithstanding this, based on a cervical MRI performed on April 2, there was nothing more the defendant should have done on March 21. Dr. Haglund’s opinion was that findings on an MRI performed on March 21 (the day of surgery) would have been essentially the same as the findings of the April 2 MRI. Those findings reflected mild compression which was not the cause plaintiff’s permanent injuries; the permanent injuries were due to Brown’s Sequard Syndrome which was caused by an ischemic spinal cord stroke not cord compression.
Defendant’s anesthesiology expert, Dr. Pajewski, testified that the plaintiff experienced significant hypotensive episodes during surgery, and how responsibility to monitor the blood pressure would have rested with the anesthesiologist rather than the neurosurgeon. Dr. Pajewski was not, however, asked for opinion regarding the care rendered by the anesthesiologist or standard of care or causation opinions as to the defendant.
Defendant’s other expert, Dr. Haglund, testified that any minimal compression on plaintiff’s spine was not the cause of her injury because an injury caused by spinal compression would not have shown any improvement to her MEPs throughout the course of the procedure or post-operatively. Furthermore, he explained that the plaintiff’s loss of blood pressure during the procedure likely caused her injury and it would not have been appropriate for the defendant to attempt a second surgery to relieve the alleged pressure on her spine because hypotensive episodes during a second surgery would have placed the plaintiff at increased risk for further damage.
Following a five-day trial and after several hours of deliberations, the jury returned a defense verdict. No appeal or post-trial motions were filed.
Type of action: Civil/Medical Malpractice
Injuries alleged: Cervical Spine compression secondary to use of intraoperative hemostatic agents resulting in Brown Sequard Syndrome following a 3 level anterior cervical disc fusion.
Court: Roanoke City Circuit Court
Case no.: CL15-2110
Name of judge or mediator: Judge David B. Carson
Special damages: $358,767.24
Verdict or settlement: Defense Verdict
Attorneys for plaintiff: Robert W. Mann, Martinsville; Patrick A. Malone and Alfred A. Clarke, Washington, DC
Attorneys for defendant: Walter H. Peake III and Mathew E. Kelley, Roanoke
Plaintiff’s experts: Martin D. Herman, MD, neurosurgeon; Roger Bhojwani, MD, radiologist; Michael Lobatz, MD, neurologist
Defendant’s experts: Michael M. Haglund, MD, neurosurgeon; Thomas Nikolaus Pajewski, MD, anesthesiologist
Insurance carrier: Proassurance