Dura Punctured During Micro Discectomy

Case Overview
Plaintiff had an L4/5 microdiscectomy performed by Dr. on 4/15/2013. During the operation the physician punctured the dura but did not notice. After having significant leakage Dr. operated again two weeks later for a Durotomy Repair. At the end of the operation he sealed the wound and valsalva showed “no significant leakage”. On May 13, 2013 Dr. conducted a wound investigation due to preoperative diagnosis of persistent dural leak. He discovered limited to no drainage. He closed and valsalva times three did not show drainage.

Patient continued to have trouble and went to Dr. # 2 who performed surgery on 9/05/2013. The preoperative diagnosis included seudomeningocele, recurrent herniated nucleus pulposus, Multiple surgeries including postop infection previously, and Intractable back and leg pain. Dr. # 2 performed 1. a Partial L3 laminectomy, Partial L4 laminectomy, Partial L3 laminectomy; 2. Removal of extradural mass nonneoplastic Pseudomeningocele with repair of Pseudomeningocele; 3. Microscopic dissection; and 4. L4-5 discectomy. Patient’s postoperative diagnosis was identical to his preoperative diagnosis. He has had significant problems post surgery.

Issue
1. Was Dr.’s initial puncture of the dura a breach of the standard of care?
2. Was Dr’s failure to properly repair the dura and deal with the Pseudomeningocele a breach of the standard of care?

medQuest Expert Opinions:

Generally speaking, CSF leak after a dural tear is considered to be a complication that occurs in the absence of negligence. It is absolutely possible for a dural tear to be present but not recognized by a surgeon. Also, some dural tears are devilishly hard to close, and I would not automatically consider it malpractice for a csf leak to recur even more than once. Dr JH – Neurosurgeon

1. Was Dr’s initial puncture of the dura a breach of the standard of care.

No, this happens to everyone

2. Was Dr.’s failure to properly repair the dura and deal with the Pseudomeningocele a breach of the standard of care.

Doubtful. The only way to actually know is to be there. I doubt there is anything in the record to support malpractice. Dr JH – Orthopedist