CASE NO: 2094/2007 In the matter between:
CHARLES OPPELT Plaintiff
and
THE HEAD: HEALTH, DEPARTMENT OF HEALTH,
PROVINCIAL ADMINISTRATION: WESTERN CAPE First Defendant SOUTH AFRICAN RUGBY FOOTBALL UNION Second Defendant
BOLAND RUGBY FOOTBALL UNION Third Defendant
MAMRE RUGBY FOOTBALL CLUB Fourth Defendant
SUMMARY IN TERMS OF RULE 36(9) (b) IN RESPECT OF DR DENNIS NEWTON
BE PLEASED TO TAKE NOTICE that the opinions of Dr Dennis Newton and the reasons therefor are set out below:
1. Dr Newton is an orthopaedic surgeon who has extensive experience in the treatment of patients with spinal cord injuries. He was the director of the Spinal Unit at the Conradie Hospital, Pinelands, Western Cape and is now employed by the Spinal and Rehabilitation Unit at Stoke
Mandeville, the pre-eminent unit of its kind in England. Conradie Spinal Cord Injuries Centre was founded by Dr Mittie Retief and Dr Aillie Key, a lady who trained under Sir Ludwig Guttmann at Stoke Mandeville Hospital.
2. During Dr Newton’s tenure at Conradie Hospital, 113 patients with spinal injuries from playing rugby were treated at the unit. Of them, 57 patients had facet joint dislocations which were amenable to closed reduction.
3. Dr Newton considers the scrum to be a phase of the game with higher risks of spinal injury particularly for front row players, and the hookers.
4. A facet joint dislocation involves the misalignment of the spinal canal between adjacent vertebrae resulting in partial occlusion of the canal.
This causes the narrowing of the space available to accommodate the spinal cord within the spinal canal and compression of the spinal cord.
Facet dislocations can be unilateral, involving only one side of the facet joints of a pair of vertebrae, or bilateral, involving facet joints on both sides. Bilateral facet dislocation causes a greater occlusion of the spinal canal than a unilateral facet dislocation, and consequently greater compression of the spinal cord.
5. Dr Newton practised a closed reduction technique at Conradie Hospital. This involves the patient being put into traction to enable the
facet joints to be returned to their correct positions. The procedure is typically monitored by means of an x-ray device. Once the correct position of the vertebrae is achieved, the patient’s neck is placed in extension, which then reduces the dislocation and restores proper alignment of the spinal column.
6. The result of this process is that the spinal canal is restored to its proper size which releases the compression of the patient’s spinal cord.
7. Reductions need not be performed only according to this closed technique, but may also be done surgically, which are termed open reductions. Closed reductions have the benefit that they are performed on a conscious and awake patient with the use of analgesia rather than anaesthesia, so that the patient is able to respond to the various stages of the process and can be monitored neurologically.
8. Of the 57 patients referred to above, 14 received closed reductions within 4 hours. Nine of those patients (64%), recovered fully. In all cases the patients were in various degrees of tetraplaegia on admission and would have been permanent tetraplaegics if their cervical dislocations had not been rapidly reduced. Of the 43 patients who did not receive closed reductions within 4 hours, only two made full recoveries (4%).
9. The reduction procedure can only benefit a patient whose spinal cord is compressed rather than transected. Typically, in facet dislocations as a result of low velocity injuries, the cord is not transected. Neck injuries suffered by rugby players are typically low velocity injuries.
10. The Plaintiff’s lesion was incomplete. He falls within the class of patients that is likely to have benefited substantially from reduction of the facet dislocation within four hours, with the likelihood of recovery.
11. The need for early reduction of facet dislocations within four to six hours was well-known in the Western Cape Orthopaedic community at the time that Dr Newton was practising in South Africa, which includes March 2002. The results he had achieved at the Conradie Hospital Spinal Unit were disseminated by means of presentations at congresses of the South African Orthopaedic Association and Spinal Society. He also lectured to the paramedics of the Department of Health of the Provincial Administration: Western Cape.
12. Dr Newton was advised that on examination by Dr Baalbergen it was found that the Plaintiff has full and normal sensory function in all modalities (pain, temperature and light touch) and sensation for bladder filing and bowel emptying, however bladder and bowel control is lacking. He has some motor function below the level of injury with
relatively normal function in the C6, C7 myotomes on the left and right.
In the C8 myotome function is preserved to a near normal level (power 4/5) on both sides. In T1 on the left side he has grade 2/5 function. There is also function of the toe flexors and extensors on the left with power 3/5.
13. Dr Newton was involved in the establishment of the Spine Line Service by SA Rugby and worked with the Chris Burger Petro Jackson Fund.
DATED AT CAPE TOWN ON THIS 2nd DAY OF FEBRUARY 2010.
_____________________________
SCHEIBERT & ASSOCIATES Attorneys for Defendant
4th Floor Waalburg Building 28 Wale Street
CAPE TOWN
(Ref: HPW Scheibert/J Murray/W02081)
TO: THE REGISTRAR
Western Cape High Court CAPE TOWN
AND TO: STATE ATTORNEY
First Defendant’s Attorneys 4th Floor, Liberty Life Building 22 Long Street
CAPE TOWN
(Ref: LM GAVA/2063/03/P8)
AND TO: DE KLERK VAN GEND
Second Defendant’s Attorney 3RD Floor, ABSA Bank Building 132 Adderley Street
CAPE TOWN
(Ref: AF BRAND/70034267)
AND TO: MALHERBE HANEKOM INC Third Defendant’s Attorney 295 Durban Road
BELLVILLE
(Ref: CL Faure/Natasja/F995) c/o JAN S DE VILLIERS
18TH Floor, 1 Thibault Square CAPE TOWN
(Ref: JJ Niemand)
AND TO: MAMRE RUGBY FOOTBALL CLUB Fourth Defendant
P O Box 57 MAMRE
Also by facsimile: 021 591 3454
