A 79 year old who had cervical stenosis and spinal cord compression C3-T1. Dr. performed an anterior cervical discectomy and fusion with allograft bone and plate C3-C6. Postoperatively he was noted to have increased weakness of his right arm, primarily in the deltoid and biceps as well as some mild weakness in his right lower extremity. He was sent to rehab where it discovered he had clear fluid leaking form the incision. He was transferred to Medical Center 5 days later were Dr. did a repair of the spinal fluid leak and repaired a C4 fracture that was discovered just prior to surgery. He continues to have physical therapy and electrical stimulation, however progress of his right arm has been slow. Due to his disability he is no longer able to work at his job at an insurance company.
What could cause the right arm paralysis post-operatively? If poor surgical technique, would that be a breach in the standard of care? Is paralysis a known risk associated with this surgery?
medQuest Expert Responses:
Neurologic injury is a complication of surgery that is not automatically assumed to be a consequence of negligence. If the weakness was primarily limited to the bicep and deltoid muscle, it could be a manifestation of the C-5 nerve root paralysis syndrome, something that is quoted to occur in five or even 10% of cervical spine procedures that involve the C4/5 level. No one knows what is the real mechanism that causes it, but it certainly occurs in the hands of all surgeons, experienced and careful ones included. For this to be a strong case, it would need to have some feature that would speak for a departure.
DR JH – Neurosurgeon
Unfortunately, paralysis is a known risk for the surgery.
Dr SB – Neurosurgeon