A 50 year old engineer was seen by a neurosurgeon with an increasingly severe back pain. He was on strong pain killers and had been unable to work for several months before the consultation.

An MRI scan showed severe spinal stenosis at T11/T12 level. The surgeon advised spinal decompression and the patient agreed to this. He underwent a posterior discectomy at T11/T12 level. Postoperatively he complained of pain and weakness in the left leg and thigh and loss of movement in the right leg. A further MRI scan suggested a haematoma at the level of T12. He had emergency surgery to remove the haematoma but there was no improvement postoperatively. Although he had bladder and bowel control he was left with considerable weakness of the lower limbs. He was unable to walk and was no longer able to work. He sued the surgeon.

When the records were checked it was noted that the surgeon had not discussed or warned the patient of the possible risks of neurological complications. Several expert neurosurgeons who reviewed the case were of the view that posterior transdural approach undertaken by the surgeon for removal of a central thoracic disc protrusion had a much higher risk of spinal cord injury compared to the preferred anterior approach and fell short of what would be considered reasonable spinal surgical practice.

The case was settled for a substantial sum.

MPS writes: Clinicians are obliged to keep up-to-date in their field and undertake procedures that are recognised as standard by their peers with acceptable outcomes. Clinicians additionally need to demonstrate evidence of continuing professional education as part of their appraisal and revalidation processes.

This article is also posted under Medico Legal section.

Case reported by The Medical Protection Society (UK). September 2013