Opinion ID: 1988913
Heading Depth: 1
Heading Rank: 4

Heading: Patient CW

Text: CW was a construction worker who came to Albanna in 1998 after injuring himself at work, complaining of pain in his legs and back. He had been seeking daily or twice-daily treatment from a chiropractor for three weeks. After conducting a physical examination of CW, Albanna ordered an MRI and a CT scan and diagnosed CW with a huge disc herniation central in location at L4-L5, mild disc degeneration at L3-L4 and L5-S1, a mild bulge at L3-L4, and moderate disc degeneration at L4-L5. Based on this diagnosis, Albanna recommended that CW undergo a bilateral lumbar microlaminectomy, microdiskectomy L4-L5, and posterior lumbar interbody fusion. Albanna did not order a bone scan, a diskogram or a back brace. A posterior lumbar interbody fusion, or bone fusion, involves the insertion of a hollow metal screw, or cage, into the spine to fuse together the vertebrae to stabilize them. Before inserting a cage, a surgeon must perform a laminectomy, a procedure removing the back of the spine, to move the nerves out of the way. The cages are filled with bone and inserted into the disk space in the front of the spine. The cages hold the vertebrae in place until the bone fuses. The proper placement of the cages is crucial to prevent the cages from failing to thread into the bone. A diskectomy is a much less complex procedure and involves a simple removal of the herniated disk. In CW's surgery, Albanna filled the cages with bone material from CW's laminectomy area. Albanna also used a substance called Pro Osteon that was approved for use in bone fractures but had not yet been approved for use in surgical fusions. Albanna did not inform CW that he was intending to use Pro Osteon for an off-label purpose. After the procedure, CW complained of burning pain in his leg and occasional numbness and tingling. CW subsequently was admitted to the emergency room, complaining of severe lower back and leg pain. X-rays taken October 29, 1998, showed that the bone had failed to fuse and that the left cage had migrated and was pushing on the nerves in the spinal canal, probably causing CW's leg and back pain. CW saw Albanna in October 1998 and November 1998. Albanna's November evaluation stated that CW's diagnostic x-rays and CT scan of the lumbosacral spine show unchanged position of the Ray cages and L4-L5 and fusion in progress. The commission found that the October 1998 X-rays indicated that the position of the cages had changed and that the bone was failing to fuse. CW had subsequent surgery in March 1999 to remove the left cage and perform a bone fusion. This corrective surgery was performed by another surgeon.