Spinal Surgery Leads to Dural Tear and Spinal Fluid Leak

This case involves a patient who underwent a cervical total disc arthroplasty and placement of a cervical implant device that was met with complications. Following the procedure, the patient experienced new-onset neurological damage due to the postoperative complications including worsening and deterioration of his original condition, with persistent foraminal narrowing by postoperative osteophyte production. Furthermore, the patient sustained severe nerve impingement at C5-6, spinal stenosis, spinal abscess formation, and pain in the neck and right upper extremity with a resultant sensory loss to the hand. The patient also sustained other serious iatrogenic injuries and damages, which included a dural tear and spinal fluid leak that required further surgery and repair. The plaintiff alleged that the defendant had only previously performed the procedure a few times, and did not have the requisite skill, experience, and expertise to safely perform the novel surgical technique.

Question(s) For Expert Witness

1. Was this surgery absolutely indicated in this patient?

Expert Witness Response E-000572

Surgery is indicated in patients with cervical disc herniation causing central cord syndrome and in cervical disc herniations refractory to conservative measures. Studies have shown that an anterior discectomy with fusion is the recommended procedure for central or anterolateral soft disc herniation, while a posterior laminotomy-foraminotomy may be considered when technical limitations for anterior access exist (eg, short thick neck). Also this is appropriate when the patient has had prior surgery at the same level. An unidentified dural tear and spinal fluid leak is not accepted within the standard of care and should have been noticed during the initial procedure.