Surgery had gone ahead with no major problems until the last stage of scoliosis correction when the Intra-operative spinal neuromonitoring signals which had been small and unreliable from start were completely lost in the lower limbs. At this stage the surgeon made a judgement call of not doing the standard intra-operative wake-up test as he felt for these patients with neurological problems the wake up test was unreliable and the delay in doing this test would increase risks such as infection and other risks associated with prolongation of General anaesthesia and this risk would have outweighed any benefit of possibly reversing any neurological complications as the patient was severely disable. He therefore decided to complete the surgery.
Because of the severe pre-existing neurological problem, post-operative observations did not detect any major problems until the 2nd post-operative day that parents noticed that their child despite being in pain, does not show the shaky movement of the right leg when she is not happy with something. When they raised their concern, an MRI was performed which showed abnormality in the cord proximal to the level of surgery possibly of vascular origin possibly not directly related to the surgery itself. Although the objectives of the scoliosis surgery to make the patient sit straight in the wheelchair had been achieved, even though neurological loss was not functional for the patient, her parents were not happy and sought damages.
The trust own enquiry criticised the surgeon for inadequate preoperative assessment of the patient and insufficient discussion around the operation and implications of surgery and associated risks. In the absence of above he was further criticised for making a unilateral judgment call without discussing these scenarios with patient’s parents.
At the end, the relevant NHS trust’s lawyers agreed to settle the case by paying an agreed substantial out of court payment for damages.