ION Medical Designs

Anatomy of a Crisis: 360°Spinal Surgery and Unforeseen Complications

This case is profoundly alarming from both a surgical and medico-legal perspective.

The plaintiff presented to a surgical center for a L3-S1 disc replacement procedure - a surgery typically performed posteriorly. However, in this instance, the surgeons opted for a 360° approach, beginning with an anterior (supine) exposure. This required mobilizing and retracting the abdominal contents to access and remove the L4-S1 intervertebral disc materials.
Following this step, the patient was repositioned into the left lateral decubitus position to continue the procedure. During this portion of the operation, the surgeons identified active bleeding from the anterior incision, transforming this procedure into an emergent situation. An attempt was made to control the hemorrhage by reopening the anterior incision frantically suctioning and attempting to resorb the blood with packing materials.
Critically, the surgical center was not equipped with necessary materials to manage aortic arterial bleeding. As a result, the patient was hastily sutured during an arterial (pulsating) bleed and transferred to another facility capable of providing appropriate arterial grafting and repair.
The case underscores standard of patient care with several key points in medical malpractice and surgical risk management: complex surgical approaches increased the likelihood of critical intra-operative complications; preparedness and availability of appropriate grafting materials are essential to patient safety; and timely access to specialized interventions can be the difference between adverse surgical outcomes and recovery.
The plaintiff in this case luckily survived however, she is paraplegic. This outcome will forever change her life. Please see the below illustrative demonstrative aids created to be utilized for trial in this case.

My strategic partner in this case is Jack Walker,
Martin Walker, Attorneys at Law

https://martinwalkerlaw.com

Featured Medical Malpractice Case
Marfan’s Syndrome with Thoracic Aortic Dissection

This featured medical malpractice case is a fascinating, medically rare and difficult case. The plaintiff is a young man who suffers from Marfan’s syndrome.

Marfan’s syndrome is a genetic condition that affects the connective tissue, in our case specifically of the heart and lungs. The condition results from mutations in the gene responsible for producing elasticity to connective tissues throughout the body. The disorder leads to complications, particularly of the heart, blood vessels, eyes, and elongation of fingers, the extremities and height.

In this particular case, the plaintiff suffered from multiple aortic dissections which can be fatal if not treated. He had a prior surgery to graft the aortic arch after an aortic arch dissection. During this surgery the surgeon’s noticed his thoracic aorta was beginning to dissect. He was then scheduled for surgery to graft the proximal thoracic aortic dissection.

I collaborated with the medical malpractice defense team, who represented the surgeon in this case. He performed this delicate surgery during Covid19 epidemic which added an extra layer of difficulty in the operating room.

The illustrated series below visually depicts primarily a young man with normal/healthy thoracic anatomy and tissues. The secondary illustration represents Marfan’s syndrome as it relates to the plaintiff specifically. He had significant issues with his heart, lungs and connective tissues. The next two illustrations are of the thoracic aortic graft surgery, which was very challenging including a bypass of his heart and lungs, then cooling of his body and brain by 20 degrees. The 7th rib was partially shingled (cut) and removed, the left lung was deflated and the part of the thoracic aorta that dissected was removed and replaced with an arterial graft. The last illustration is of the surgical site closure specifically showing the left lung re-inflated. This was a VERY important surgical step due to the prosecution claiming the surgeon didn’t make sure the lung was re-inflated before initiating closure of the chest incision.

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This illustration is one of the images I created for a medical malpractice case. This drawing is based on and drawn over the plaintiffs x-ray. As you can see the surgeon miss placed the sacral screw causing a large venous bleed since the screw perforated the inferior vena cava. The IVC is the largest vein in the human body.

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