Neurology Experts Discuss Lack of Informed Consent During Nerve Resection

This case involves a male patient in Idaho with a medical history of cancer, which had been successfully treated. On the date of the incident in question, the patient underwent surgical resection of suspicious lymph nodes. Prior to the surgery, the patient had discussed with his surgeon his desire not to have any damage to his spinal accessory nerve. However, the informed consent made no mention of the potential for resection of the nerve. During the surgery, the surgeon decided to remove the nerve, and called in a plastic surgeon to perform a transplantation of a portion of another nerve in a graft. As a result, the patient lost the use of his right arm post-op. As a result, the man was unable to return to his previous occupation as a golf instructor.

Question(s) For Expert Witness

1. Have you ever treated a patient similar to the one described in this case?

2. Is it possible that the patient's symptoms were caused by the intra-operative nerve resection/grafting?

Expert Witness Response E-019259

I have treated patients with mononeuropathy of the spinal accessory nerve. In one case, the injury was related to lymph node resection or biopsy. Injury to this nerve is a known complication of posterior triangle lymph node biopsy. It is a possible that the patient's symptoms were caused by the procedure. A 50% loss of an upper extremity would not be expected from an isolated injury to the spinal accessory nerve. If one has bona fide CRPS, then there could be greater limitation. Moreover, there may be an issue with lack of informed consent. In addition to board certification in Neurology and Headache medicine, I am certified in Clinical Neurophysiology and Electrodiagnostic Medicine, both of which involve the study of the peripheral nervous system. I have been in practice for 13 years post neurophysiology fellowship training.