Orthopedic Surgeon Lacerates Patient's Nerve

Case Overview

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.

Questions to the Orthopedic Surgery expert and their responses

Do you routinely perform anterior cervical discectomy and fusion with plating in your practice?

I routinely perform anterior cervical discectomy fusions.

What are the common complications following an anterior cervical discectomy and fusion?

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.

What is the protocol for managing malpositioned screws or instrumentation post-operatively?

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.

About the expert

This expert has over 25 years of experience in the field of orthopedic surgery, specializing in spinal surgery and foot and ankle surgery. He earned both his BS and his MD from the University of California at Los Angeles. He remained there for his residency in orthopedic surgery before completing a prestigious fellowship in spine surgery at Cedars-Sinai Medical Center and another fellowship in foot and ankle surgery at the University of Texas Southwestern Medical Center. Today, this expert is board-certified in orthopedic surgery and is very active in their field as a member of multiple professional societies, including the North American Spine Society and the American Academy of Orthopedic Surgeons. Formerly, he served as an orthopedic surgeon at Girard Orthopedic Surgeons, Greenville Orthopedics and Sports Medicine Center, Advanced Orthopedic Care Associates, South Bay Orthopedic and Sports Medicine, and Phoebe Putney Memorial Hospital. Currently, he is an orthopedic surgeon at a private practice in Georgia.