Duty of Care of the Spinal Surgeon after surgery

Category: Medical Negligence

A recent case:

In a recent case the Court of Appeal has rejected the appeal of a neurosurgeon. There was a finding last year against Mr Christos Tolias, suggesting that he was negligent in his treatment of a patient, Mrs Yvonne Lesforis.  Mrs Lesforis was suffering from back pain and sciatica in 2007 and was diagnosed with a condition called spondylolisthesis.  This is a condition where one of the spinal discs slips and overlaps an adjacent disc.  It causes a narrowing of the spinal canal which can then put pressure on the spinal nerves causing leg pain.  A number of conservative treatments failed to work. Mrs Lesforis eventually agreed to having decompression surgery under the care of Mr Tolias.  The operation appeared to go well but the troubles in this case started after the surgery.

After the Surgery

About 3 hours after the surgery she was administered some “clot busting” medication to reduce the risk of deep vein thrombosis. This was one of the risks encountered after surgery.  However, in this case the drug caused internal bleeding which put pressure on Mrs Lesforis’ spinal nerves. Therefore causing partial paralysis and she ended up largely wheelchair bound.

What happened next?

Mrs Lesforis bought a claim for medical negligence against the surgeon, Mr Tolias.  One of her complaints was that it was negligent of him to have administered the clot busting drug so soon after her surgery.  Mr Tolias’ evidence was that he routinely gave this medication to all his patients.  Mrs Lesforis’ claim supported by her own expert evidence was that because of the risk of bleeding and compression of the spinal nerves, this medication should not be given in the very early post-operative period following spinal surgery.  To do so within the first  hours increased the risk of the internal bleeding.


She argued that it would have been a much safer option to administer the drug at the 12 – 24 hour point post-operatively.  Her expert witness confirmed that no reasonable body of surgeons would accept that it was reasonable to have administered the drug within 6 hours of major spinal surgery let alone 3 hours.


In medical negligence cases there can be varying differences of medical opinion. If the doctor can establish that what he or she did would be supported by a reasonable body of medical opinion then he or she is likely to escape a finding that they have been negligent.

The results

The Court of Appeal decided that the Trial Judge was entitled to find that the surgeon had been negligent in this case. It was found that negligence had caused or at least materially contributed to Mrs Lesforis’ injury and subsequent severe disability.