On Sept. 26, 2013, plaintiff Harriet Hadelman, 68, a retiree, was administered local anesthetic prior to undergoing a left cervical facet steroid injection at the C4-5 level at the medical offices/ambulatory surgery center of Dr. Lee Erlendson, a pain management physician. During the local anesthetic administration process, Hadelman complained of a brief episode of intense pain in neck and paresthesia down her left arm and leg. However, the condition resolved almost immediately, and she was discharged home in stable condition. Approximately 30 minutes to one hour later, Hadelman developed severe neck pain. As a result, she returned to the clinic, was admitted to the hospital, and released after a day. An MRI ultimately showed a cervical cord lesion. Hadelman claimed that she continues to suffer neuropathic pain in her left neck and left upper extremity. Hadelman brought a complaint against Erlendson, alleging that Erlendson failed to properly administer the local anesthetic and that this failure constituted medical malpractice. Plaintiff’s counsel contended that when using even a 1.5-inch needle during a local anesthetic administration, the standard of care required the use of fluoroscopy in order to prevent the needle from deviating from its intended course and striking the cord. However, counsel asserted that since Erlendson failed to use fluoroscopy, the 1.5-inch needle directly penetrated the cervical spinal cord and caused the left, posterior, cervical cord lesion at C3-4, as seen on MRIs of the cervical spine. Counsel further asserted that the cervical cord lesion caused Hadelman’s subsequent neuropathic pain complaints in the left neck and left upper extremity. Defense counsel contended that the standard of care did not require the use of fluoroscopy while using a 1.5-inch needle to administer local anesthetic. Counsel also asserted that it was physically impossible, to a reasonable degree of medical probability, for the 1.5-inch local anesthetic needle to have reached Hadelman’s cervical spinal cord at the C3-4 level and/or at C4-5 level based upon the actual measurements of Hadelman’s cervical anatomy from skin surface to spinal canal/cord. This was demonstrated by defense animations, including the depiction of cross-sectional axial MRI images, which showed that the needle simply could not reach the cord. Defense counsel contended that every measurement depicted on the animation and testified to by the defense experts was greater than 1.5 inches. In addition, counsel contended that the evidence demonstrated that the needle was not even fully into Hadelman’s skin during the local anesthetic administration when Hadelman complained of pain and paresthesia down her left arm and leg. Although it was not the defense’s burden, an animation was presented that depicted the vascular anatomy of the cervical spine. The defense’s medical experts then used the animation to present a theory to the arbitration panel that the cervical cord lesion was caused by the needle striking a nearby artery — a branch of the ascending cervical artery in the posterior aspect of the cervical musculature at C4-5 — causing it to go into vasospasm, resulting in the formation of a blood clot. The experts also opined that the blood clot embolized to the spinal cord, causing an infarct and subsequent tissue death, such as a spinal cord stroke or infarction similar to a cerebral stroke., An MRI showed that she had sustained a cervical cord lesion. Hadelman claimed that the cervical cord lesion resulted in a phrenic nerve injury that caused hemi-diaphragmatic paralysis, which affects pulmonary and respiratory muscle function, and hypoxemia, which is abnormally low level of oxygen in the blood. She alleged that as result, she suffers from neuropathic pain in her left neck and left upper extremity and requires the use of 24-hour supplemental oxygen. Hadelman claimed that her permanent neuropathic pain and accompanying disabilities prevent her from performing activities of daily living. She alleged that as a result, she requires five hours per day of attendant care. Thus, Hadelman sought recovery of medical costs, and damages for her past and future pain and suffering. Her husband, Stephen Hadelman, sought recovery of damages for his loss of consortium. Defense counsel contended that Hadelman did not begin to develop her alleged neurologic complaints, such as neuropathic pain, until several days after the surgery, when she saw a neurosurgeon on Oct. 3, 2013. Counsel also contended that the alleged phrenic nerve injury was not “diagnosed” until late 2015 and that this delay in diagnosis showed that the alleged injury could not have been attributed to the cervical lesion. Defense counsel further asserted that Hadelman’s cervical cord lesion, to a reasonable degree of medical probability, would not cause a phrenic nerve injury because it was located posteriorly, versus anteriorly, in the cord, as the motor neurons giving rise to the phrenic nerve are located in the anterior horn of the cord. Moreover, defense counsel asserted that the diagnostic test evaluating for diaphragm paralysis — a SNIFF fluoroscopic medical test — was negative.