C underwent surgery on 22 February 2018 to excise a large calcified prolapsed thoracic disc at the T10/11 level. He was aged 42. The operation was carried out by a consultant neurosurgeon… As a result of injury sustained to his spinal cord during the course of that operation, C was rendered paraplegic (incomplete paraplegia, T10 AIS C). It is C’s case that the spinal cord injury was a result of negligence on the part of D. D denies negligence. [2]
the relevant disc as a very large (also properly described as “giant”) prolapsed disc which was both central and eccentric to the right and which displaced the spinal cord posteriorly and to the left. C gave consent for, amongst other matters, a costotransversectomy which is a procedure which involves the removal of part of the head of a rib in order to facilitate a posterior-lateral approach to the prolapsed disc. [3]
a costotransversectomy was an appropriate surgical approach for this disc… there is a risk of spinal cord injury (and resulting paraplegia) of 5-10% for all relevant approaches in respect of this type of thoracic disc prolapse. [4]
The [operation] note records that following initial surgery to provide access to the disc… it was not possible to strip the dura mater off the calcified disc due to adherence of the disc to the dura. It records that consideration was given to removal of the rib (part of the costotransversectomy), but that it would still not be possible to remove the disc without injuring the dura. The note records that it was decided to approach the disc transdurally, that is, by opening up the dura. [5]
after opening the dura the spinal cord was ‘mobilised gently to the left’ to expose two thirds of the disc. Following removal of the majority of the disc ‘a small sharp portion [of the disc] towards the left’ was noted to be ‘digging into the spinal cord’. The spinal cord was ‘gently mobilised to the right’ to expose that smaller rim remnant, which was removed with rongeurs. The note also records that at this stage the neurophysiology monitoring showed a drop in the motor evoked potentials for the left leg to 60%. The surgery was paused for around 25 minutes, by which time the MEPs had recovered to about 75-80% of the starting amplitude. The note records that the operation was ended at that stage and no further attempt was made to remove any more of the remnant disc material. [6]
C alleges, in summary, that D acted in breach of duty: (i) in abandoning the costotransversectomy; (ii) in adopting the surgical approach taken; and (iii) in respect of retraction and/or manipulation/mobilisation of the spinal cord. [7]
Following the operation, C woke with worse neurological deficit in the right and left legs than pre-operatively. [8]
D did not breach the duty of care which it owed to C in respect of any of the three pleaded particulars of breach. [199]
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