CINCINNATI – A jury got a nearly four-hour lecture in Spine Surgery 101 from an expert witness testifying against Dr. Atiq Durrani Thursday.
The indicted Mason spine surgeon made a “rookie error” while performing a second and unnecessary surgery on Crystal Pierce in 2009, Dr. Keith Wilkey testified in a marathon video deposition on Pierce’s behalf.
Wilkey, an experienced spine surgeon himself, blamed Durrani's mistake and negligence for putting Pierce through months of severe pain.
“I signed the affidavit of merit with trepidation because, you know, this is a very serious matter, but I felt that from Dr. Durrani’s notes, as well as what the radiologist has said, the second surgery was unnecessary,” Wilkey said.
Wilkey contended that Durrani:
➢ Used a commercial bone growth protein (INFUSE) in his first surgery on Pierce even though the North American Spine Society had “specifically warned against it in the type of surgery Dr. Durrani performed.”
➢ Misread or disregarded X-rays in performing a second operation on Pierce.
➢ Chose a more painful and complicated procedure that most U.S. surgeons avoid.
➢ Made a critical error in placing screws and panels in Pierce’s spine, worsening her condition.
The last was the "rookie error," as Wilkey described it. Wilkey said Durrani "malpositioned" five plates and at least 10 screws, causing pressure around the spinal cord.
Ultimately, Pierce went to another surgeon and had the plates and screws removed, Wilkey said.
"It's my opinion that it caused at least half of her pain syndrome, probably more than half, as evidenced by the mere fact that when they were removed, she improved," said Wilkey, who operates out of St. Louis.
"It was stabbing pain before surgery, not constant," Pierce testified Wednesday. "After surgery it was stabbing, constant pain, but I also felt like when I would move, it felt like someone was taking a knife and just ripping by that scar."
Pierce’s suit is the first of 175 filed by Durrani patients to go to trial. Some, like Pierce, contend Durrani's surgery made their conditions worse.
RELATED: Read Pierce’s lawsuit
It didn’t start that way. Durrani’s first surgery on Pierce was helpful, Wilkey testified.
Wilkey and Pierce’s lawsuit detailed Pierce’s early surgical history this way:
➢ In October 2007, Pierce had a herniated disc and stenosis . Dr. Paul Cohen of Mayfield Clinic performed a fusion of the C6-C7 vertebrae. It was done well and Pierce had good results, Wilkey said.
➢ By January 2009, Pierce had neck pain that shot down the back of her right arm into her fingers, as well as numbness and tingling on her right hand. After Cohen recommended non-surgical treatment, she went to Durrani for a second opinion.
➢ Durrani told Pierce she was in grave danger of being paralyzed unless she had immediate surgery.
➢ On Jan. 28, 2009, Durrani performed anterior cervical discectomy and a fusion of C5-C6.
“Ms. Pierce had a good results from that,” Wilkey said. “Her symptoms essentially resolved with regards to her arm and neck pain.”
➢ Two days later, Durrani performed a C3-C7 laminoplasty . But instead of entering through the front part of her neck, as it most common, Durrani went through the back, Wilkey said. That’s more difficult and painful because the surgeon has to cut through muscle and bone, Wilkey said. Five days later, Pierce was still in the hospital and in pain. Normally, patients are released the next day, Wilkey said.
“This is where Dr. Durrani and I are going to disagree,” Wilkey said.
“There are some patients that have such horrible neurologic finds or they have very bad X-rays or MRI studies that just operating from the front - the easier, less painful of the methods available - (isn’t) enough, and then we have to go to the back of the neck and put the patient through that particular painful procedure. It’s not a preferred method of doing things, but there are patients who need it.”
The bottom line, Wilkey said, is this:
“I believe he (Durrani) fell below the Standard of Care for two reasons. Primarily, the first being, I don’t think her conditioned warranted (the second surgery.)"
The second reason was the use of INFUSE, Wilkey said. By 2009, studies had determined that it could cause too much bone growth and swelling, Wilkey said.
Wilkey went to painstaking detail and used a model of a spine to demonstrate its intricacies and make his points. By the time it was over, jurors learned a glossary of spine-related terms.
Neverthless, the video deposition taxed the attention span in the jury box in Visiting Judge Guy C. Guckenberger’s courtroom. Like students, some jurors took notes and others drifted off briefly as the single image of Wilkey speaking burned into the old, white movie projection screen in the middle of the courtroom.
Durrani isn't here to testify. He fled to his native Pakistan last month in the wake of a 36-count federal indictment and the civil suits filed by attorney Eric Deters. Durrani gave a deposition in November and the trials will go on through that.
government has charged Durrani with performing unnecessary surgeries and billing insurers millions of dollars for fraudulent services. Durrani was also stripped of his licenses in Ohio and Kentucky.
Deters said he plans to file another 230 suits by the end of February.
RELATED: Read the indictment.
Durrani professed his innocence in an exclusive interview with WCPO's Tom McKee last August.
The federal charges carry a potential prison sentence of up to 125 years. The indictment also seeks forfeiture of any proceeds Durrani received as a result of his alleged scheme.
Durrani owns a private practice called the Centers for Advanced Spine Technologies (CAST) with offices in Evendale and Florence and most recently performed surgeries at JourneyLite in Evendale, where he is part owner.
Between 2007 and 2013, Durrani performed surgery at West Chester Hospital UC Health, Children's Hospital, Good Samaritan, Christ and Deaconess, but he no longer has privileges at any of those hospitals, the indictment says.