November 18, 2012

ENT Surgeon Sues Spine Surgeon for Wrong Sided Surgery

Wrong sided surgery is extremely rare occurring anywhere from 0.09 to 4.5 per 10,000 surgeries performed.

It is almost unheard of when the patient is a surgeon as well.

On Nov 13, 2012, media reported that an ENT surgeon (plaintiff) sued his spine surgeon (defendant) over wrong-sided surgery.

The ENT surgeon had spine surgery in 2011 for low back pain which was allegedly due to pinched nerves. The treatment called for laminectomy surgery on the right side which entails bone removal to prevent the nerves from being pinched further thereby alleviating pain.

However, the ENT surgeon claims wrong-sided surgery in that left back surgery was performed rather than the right side. The spine surgeon claims he performed a left-sided approach to the right side.

Here's a video news report which includes radiological images that does appear to show bone removal on only the left side (rather than the correct right side).

Although it may seem like an open and shut case of malpractice for wrong-sided surgery, as in most cases of medicine, it is not that straightforward.

Given I'm not a spine surgeon, I asked my good colleague Dr. Jeffrey Wise who is a spine surgeon with Blueridge Orthopedic and Spine Center to comment further in this particular case.

After review of available publicized information, Dr. Wise felt that there were several possible explanations of what may be going on:

1. It was truly wrong-sided surgery that the spine surgeon is trying to cover up.
2. The correct surgery WAS done utilizing an opposite side technique.
3. It may be lack of informed consent on the part of the spine surgeon (the approach was not explained clearly to the patient).
4. The ENT surgeon may have misinterpreted the informed consent and not understood the procedure.
5. The correct procedure was done and the ENT surgeon did not have the result he was hoping for or he may have wanted to be disabled for secondary gain.

Some facts...  It is possible to do right-sided back surgery via a left-sided approach as illustrated in the textbook diagram shown in the video with the tubular retractors.

In fact, it is indeed easier to decompress the lateral recess and exiting nerve root of the spine from the opposite side via the open approach. The surgery can also be done via a minimally invasive approach (as in this case), but it is not considered standard approach of most spine surgeons who would usually use the tubular system and go on the same right side for a unilateral decompression.

On another note, the decision on the necessity for spine surgery is interesting because in the pre- and post-axial MRI pictures shown in the video, while there is clearly a spine defect on the left, the pre-op picture does not show any pathology that suggests surgery was even needed. Perhaps there are more images that do show the nerve compression better, but they are certainly not shown in this article.

From a legal standpoint, it would be possible to prove or disprove that wrong-sided surgery was done if there is clearly bone removal visualized from the right side (presuming spinal stenosis was the diagnosis for which surgery was performed) or a disc herniation was no longer visible (if a disc herniation was the problem). This scenario would favor the neurosurgeon.

However, if the bone on the right side (or disc herniation) was still present, that would favor the ENT surgeon.

Unfortunately, based on the limited publicized images shown, it is impossible to clearly tell from the images shown or information provided in the article. Again, the images shown do not show a surgically justifiable lesion to begin with and only show bone removal from the left spine.

INVESTIGATION: Surgeon v. Surgeon in wrong-side surgery case 11/13/12

Avoiding wrong site surgery: a systematic review. Spine (Phila Pa 1976). 2010 Apr 20;35(9 Suppl):S28-36.
Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids.

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