This case involves a 49-year-old male patient with a history of a previous herniated disc who suffered another herniated disc after heavy weight lifting in the gym. The patient initially underwent an anterior cervical discectomy and fusion. Two weeks after the surgery, the patient complained of severe discomfort. An MRI was performed and showed a possible malpositioned screw. The patient was then taken back to the operating room to remove the screw. During this procedure, the operating surgeon lacerated the patient’s vertebral vessel. A vascular surgeon was called into the operating room to clamp the artery and stop the bleeding. It was later determined that the vessel in question was a vertebral artery. Following this second procedure, the patient began experiencing decreased motor function, pain, and eye drooping. The patient subsequently lost complete motor function in both arms and was unable to return to work. It was alleged that the orthopedic surgeon lacerated the patient’s nerves during the revision surgery.
Question(s) For Expert Witness
- 1. Do you routinely perform anterior cervical discectomy and fusion with plating in your practice?
- 2. What are the common complications following an anterior cervical discectomy and fusion?
- 3. What is the protocol for managing malpositioned screws or instrumentation post-operatively?
Expert Witness Response E-000634
I routinely perform anterior cervical discectomy fusions. In my practice, great care is taken to make sure the screws are in the right place. The potential complications can include patient-related factors (friable tissues, unusual anatomy, etc.) or surgeon/technique related factors. The actual incidence of complications occurring is relatively low for most surgeons. It would appear that the matter may be determined by how badly the surgeon deviated from proper fluoroscopic monitoring while implanting the device. A screw placed too far posteriorly should be noted at the time of surgery. It would be rare to find such a problem afterwards and not during the final radiological exam, prior to closing, suggesting variation from the normal procedure. If there are any concerns, a 3-D CT should be checked to confirm screw placement. If significant and symptomatic, the screw should be revised and/or removed in a timely matter to avoid subsequent surgery or further surgical complications from nerve laceration.