Endoscopic Percutaneous Discectomy Results in Paralysis

This case involves a fifty-one-year-old female patient who underwent an endoscopic/percutaneous discectomy for a lumbar disc prolapse. Unfortunately, the patient was left with hemiparesis of the lower extremity as a result. The plaintiff had a herniated disc in the L4/L5 region. She went to the defending doctor for an MRI, where they confirmed they could perform the endoscopic surgery. The next morning, they performed two studies prior to the surgery: The first, a discogram where they put material gadolinium into disc space and to inflate the herniated disc and then a CAT scan. Just before surgery, as she was being taken to the OR and under sedation, the physician looked at her and stated, “I don’t know if I could do this one”- from the looks of the discogram and CAT scan. He proceeded with the surgery against his better judgment. Postoperatively, the patient was unable to move her lower extremities. Months later the patient had an MRI showing the exact same herniation still in place. The treating physician recommended a laminectomy to alleviate the paralysis. However, the patient does not have insurance and cannot cover the medical costs of an additional procedure.

Question(s) For Expert Witness

1. What are the indications for an endoscopic percutaneous discectomy?

Expert Witness Response

The purpose of surgery for symptomatic lumbar disc prolapse is to relieve symptoms due to inflammation of, or pressure on, affected nerve roots by removing part of, or the entire, disc. Minimally invasive techniques involve smaller incisions and surgery with the aid of indirect visualization; some techniques employ lasers to vaporize parts of the disc or automated techniques for removing portions of the disc. They have the potential advantage of quicker recovery from surgery compared to standard open discectomy or microdiscectomy. Major post-operative complications are rare for any of the discectomy procedures. That said, more serious cases need to be corrected via open discectomies. Hence, the minimally invasive approach is reserved for less complicated cases.