We settled a claim against Nottingham University Hospitals for a client who underwent spinal surgery in 2009. Our client was a high-achieving elite athlete who was one of the top 10 fastest female cyclists ever in the UK over 10 and 25 miles. She had Olympic ambitions but began experiencing pain in her lower back and was concerned this might interfere with her training.
Investigations revealed she had a long-standing spondylolisthesis, a condition in which one of her vertebrae had slipped forwards, causing compression of some of the nerves passing through the narrowed space between the vertebrae. Several different surgeons recommended that she needed a spinal fusion to fix the slipped vertebrae and to decompress the nerves.
In 2009, she was referred to a pre-eminent surgeon at Nottingham University Hospitals who agreed she needed spinal fusion and decompression. She understood that he would operate posteriorly through her back. When she next saw him, however, he suggested the option of operating anteriorly through her abdomen. He explained this would avoid damaging muscles in her back but, as it was an unusual option, he would need to consider it further.
Our client only saw him once again before he operated in October 2009. She was clear that he had never described any of the risks of anterior surgery compared to posterior surgery to her. In the meantime, she had an appointment with one of the surgeon's colleagues, who explained that anterior surgery would be inappropriate. He properly explained the nature and risks of posterior surgery to her and she consented to that procedure. We obtained evidence from that colleague that her original surgeon had discussed her case with colleagues, all of whom advised against operating anteriorly.
Our client then received a call from the surgeon's secretary to say that he still had not decided whether to operate anteriorly but would discuss this with her. Our client did not see him again before the surgery but was told on the morning of her operation that the surgery would be done anteriorly. She was anxious and asked to speak to the surgeon himself. She was told he was unavailable and, if she did not agree to the surgery that day, her surgeon was retiring and would be unable to operate. She was very distressed when she agreed to the surgery.
Sadly, the surgery did not achieve its intended outcome. She was left with very significant pain and weakness in her legs including a left foot drop. She also suffered bladder and gynaecological problems. She was concerned these were caused because she had the surgery anteriorly and that she had never been warned of these risks before the surgery. We obtained expert evidence confirming that our client should have been advised that there were increased risks of nerve damage with anterior surgery because the surgeon cannot visualise the nerves, unlike in posterior surgery. Our expert confirmed it was highly likely the nerves had been over-stretched, causing our client’s pain and motor problems after the operation. This may also have caused her urological and gynaecological symptoms.
Revision surgery under a different surgeon gave our client some improvement but she is left with pain and long-term weakness that affects her ability to stand for long periods. She has never been able to return to sports at anywhere near her previous high level. Her symptoms also interfere with her work.
Our client's case was that, if she had been told before the operation of the risks of anterior surgery compared to posterior surgery and, particularly, if she had known the surgeon would not be able to see the nerves he was trying to decompress, she would not have agreed to the anterior approach.
The hospital denied throughout that the surgeon had failed in his duty to our client or failed to advise her of the relevant risks. In fact, it denied that there had been any damage caused to our client's nerves during the operation, notwithstanding her condition immediately after the surgery.
This case therefore had to issue in the High Court. The parties had exchanged their witness and expert evidence on matters of breach of duty and causation of damage before the hospital made an offer to settle the case for a six-figure sum.