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Michael A. Zuk and Vadim Braslavsky obtain defense verdict in a complex medical malpractice case pertaining to severe, permanent neurosensory impairment in the lower extremities, wherein plaintiffs, the patient and her husband, sought $2.4 mil in damages.

Plaintiffs, Lydia and Jorge Demedio were represented by Ian “Buddy.” Lydia, had a complicated orthopedic history, including bi-lateral knee and hip replacements. Despite these procedures, as of September 2006, she was complaining of 10/10 pain in the left knee/leg radiating into the hip. Conservative treatment, including epidurals and physical therapy provided only temporary relief. Starting in December 2006, the pain spread to the lower back.

On January 15, 2007, at the request of the patient’s long-time treating orthopedic surgeon, the patient was seen by Dr. Khurana for surgical consultation. Dr. Khurana comprehensively evaluated the patient and reviewed all available radiological studies, including most recent plain films and MRI. Dr. Khurana concluded that the patient’s severe intractable left-sided leg and back pain was caused by profound L3-5 stenosis, accompanied by L4-5 spondylolisthesis.

Based on these finding, Dr. Khurana discussed with the patient in detail two surgical options. One was the minimally invasive approach performing microdecompression at L3-4 and L4-5. The other, which Dr. Khurana recommended, was a vigorous decompression of the lateral recess zone with interbody fusion at L4-5 to stabilize the spondylolisthesis. The patient expressed her understanding of the risks, disadvantages and benefits of the two options and agreed to proceed with a more aggressive approach.

On January 25, 2007, the patient presented to St. John’s where Dr. Khurana performed Transforaminal Lumbar Interbody Fusion (TLIF) at L3-4, L4-5 with the use of intraoperative microscope; somatosensory evoked potential monitoring and pedicle screw stimulation; and interpretation of intraoperative fluoroscopy.

During the laminectomy portion of the procedure, when the 9 mm spacer was removed, and before the placement of PEEK cage, SSEPs had completely disappeared in the lower extremities. Dr. Khurana and his assistant surgeon took comprehensive steps to determine the etiology of the SSEP loss, including but not limited to immediately inspecting the dural sack which was visible by virtue of facectomy. Everything appeared normal and the surgery was completed.

When the patient awoke, she had neither sensation nor motor function in the lower extremities. The following day, with the patient’s consent, Dr. Khurana took her back to the operating room to further explore any potential etiology of the patient’s neurological deficits. Once again, there was nothing to explain what happened. Specifically, there was no cord compression of any kind, no hematoma, bruising of neural elements, etc. The patient subsequently underwent rehabilitation, PT/OT, and was treated for bladder incontinence. The patient eventually regained some motor and sensory function in her lower extremities but has remained largely wheel-chair bound.

Plaintiffs contended that surgery should not have been performed before first attempting physical therapy and other conservative treatment; that there was no appropriate informed consent for the surgery; and that the correct surgery would have been a simple laminectomy instead of TLIF, wherein excessive nerve retraction caused permanent nerve injury.

Dr. Khurana contended that TLIF was an appropriate surgery to address severe lumbar stenosis with spondylolisthesis, the surgery was performed properly after obtaining appropriate informed consent, and the most likely cause of Lydia Demedio’s injury was a Cauda Equine ischemic event, such as venous congestion, a rare unpredictable and unavoidable complication. Jorge Demedio claimed loss of consortium, including but not limited to the value of household services. Total damages sought were $2.5mil.

Following a 7-day trial, the jury returned defense verdict. Plaintiffs subsequently filed a motion for new trial, which was denied.