A Texas jury's $134,000 award against a spine surgeon for removing the wrong spinal disc on a patient points out the need to insist on clear imaging and carefully count vertebrae to ensure the right disc is removed.

Operating on the wrong level of the spine is one of the most common causes for medical negligence, according to the Royal College of Surgeons Edinburgh. It is worth keeping in mind that spine surgeons have the second highest number of medical malpractice cases, after OB/GYN physicians, according to the Burton Report.

In the case of Douglas and Brenda Ray v. Mignucci, the jury found that spine surgeon Luis Mignucci, MD, of Plano, Texas, mistakenly removed the T5-T6 thoracic spinal disc rather than the T6-T7 disc in patient Douglas Ray. Dr. Mignucci did not bill Mr. Ray for the first surgery and substantially reduced the bill for a second surgery on the correct disc, according to Dale R. Rose, attorney for the Rays.

Mr. Rose says Dr. Mignucci blamed the mistake on an unclear MRI image and the height of his 6-foot-2 patient, which made it more challenging to count the vertebrae correctly. Also, the herniation on the correct disc was obscured from Dr. Mignucci's view, says Mr. Rose. Stephen W. Johnson, attorney for Dr. Mignucci, could not be reached for comment.

Following the 2002 surgery, Mr. Ray and his wife Brenda filed a malpractice lawsuit against Dr. Mignucci in Collin County (Texas) District Court. They sought compensation for Douglas Ray's lost wages and the cost of the surgery, but most of the claim was for such non-economic damages as physical pain, mental anguish, loss of consortium and loss of household services, says Mr. Rose.

In 2004, the jury decided in favor of the plaintiffs and awarded $134,000 in damages, of which $94,000 went to Douglas Ray and $40,000 to Brenda Ray for loss of consortium. At the time of the trial, Texas had just adopted a $250,000 limit on non-economic damages, but the incident occurred before the law went into effect.

Several programs are in place to prevent wrong-site surgery, including the North American Spine Society's "Sign, Mark, and X-ray" program. The so-called "SMaX" program involves marking the exact site for spinal surgery with a radiopaque indicator and using a checklist for patient and procedure verification.

Leigh Page