Paraplegia caused by inadequate monitoring equipment and surgeon's failure to use imaging during operation
An NHS Trust caused a patient's paraplegia when the surgeon failed to use bi-planar imaging for the placement of a pedicle screw during a scoliosis operation. The Trust also failed to provide spinal cord monitoring equipment, causing the patient to suffer spinal cord damage that resulted in paraplegia.
The claimant suffered from scoliosis, and had undergone surgery at the trust's hospital to achieve some correction of the curvature of her spine and to prevent its progression and a significant deformity.
The operation involved improving the angle of the spine by the use of pedicle screws, hooks and rods which are anchored to the vertebrae. The surgeon used fluoroscopy to enhance the safety of inserting screws in and above the sixth thoracic vertebra and above. The spine was also manipulated to achieve correction. Following the operation, she was left paraplegic as a result of damage to her spine.
She claimed that the damage had been caused when the surgeon misplaced a pedicle screw at the sixth vertebra. The NHS trust denied this and claimed that the likely cause of the damage was manipulation of the spine once all the metalwork was in place.
The Judge decided that on the balance of probabilities, the damage to her spinal cord was caused by a pedicle screw piercing the dura and compressing the spinal cord. The reasons included the following: the surgeon did not use intra-operative imaging at the time of preparing for or inserting the pedicle screw, and at that position there was a greater chance of misplacement of the screw and the manipulation was gentle.
It became apparent from the evidence that the surgeon had found the images difficult to read, but he had failed to use bi-planar imaging, which would have shown the depth of the screw, and whether it was going too far sideways and thus impinging on the spinal canal.
Whilst it could be safe for some surgeons not to use imaging during the placement of screws, the actions of the reasonably careful surgeon would depend upon their skill and experience. In this case, the surgeon only performed a few scoliosis operations a year, and it was clear by his use of fluoroscopy that he recognised that inserting the screws at the sixth vertebra and upwards was increasingly difficult. Therefore he was negligent in not using the imaging during the placement of the screw.
In addition, the trust had failed to provide spinal cord monitoring equipment, and therefore the trust’s position fell below a reasonable standard of care in failing to provide it and was therefore negligent.
Consistent with our policy when giving comment and advice on a non-specific basis, we cannot assume legal responsibility for the accuracy of any particular statement. In the case of specific problems we recommend that professional advice be sought.
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