My Training
I am Nicholas Vyner Todd, a Consultant Neurosurgeon and Spinal Surgeon. I retired from the NHS in 2011 and from private practice in 2014. I continue to work in academic neurosurgery and in personal injury and medical negligence litigation as an expert witness.
My undergraduate training was at Guy's Hospital. My postgraduate neurosurgical training took place at neurosurgical units in Derby, London, Edinburgh, and Glasgow. I was awarded the FRCS (England) in 1982. In 1983, I became a Medical Research Council Special Training Fellow in Neurosurgery. I undertook research in experimental brain injury at the Institute of Neurology, Queen Square, between 1983 and 1984. This led to the award of an MD by the University of London and to my appointment as a Hunterian Professor at the Royal College of Surgeons of England in 1985.
Subsequently, I studied for a diploma in law and was awarded the PgDL (University of Northumbria, 2:1) in 2001. In 2010, I was awarded an Honorary Fellowship of the Royal College of Physicians of Edinburgh. My qualifications are MB BS, PgDL, MD, FRCPE, and FRCS.
A Typical Day
I spend part of my time in academic practice. I undertake original research, mainly in the area of spinal surgery, and publish three or four academic papers per year-typically on standards of care and outcomes in spinal surgical practice. I have research collaborations with several academic spinal surgery departments across the UK and act as a referee for a number of international journals reviewing papers submitted for publication.
My medicolegal practice is based in a cottage overlooking the North Sea. The practice is entirely electronic. My secretaries and I are connected via a secure network and all work remotely.
My days are varied. I might be working on a medicolegal report, reviewing medical records, witness statements, radiological imaging, and reports from other experts before compiling my own. For personal injury and some clinical negligence cases, patients need to be seen and examined to prepare a condition and prognosis report or to determine causation. Patients can be seen at my local private hospital, at home, or at another institution nationally. Remote assessments via video consultation are also available. While video consultations are convenient and cost-effective, they do not permit physical examination, which in neurosurgery can be a significant limitation.
Regular consultations with solicitors and counsel-often via video link-are part of my practice. One advantage of my current setup is the ability to prepare urgent reports and conduct consultations promptly across the UK.
Medicolegal Work
I have dealt with a wide range of personal injury and clinical negligence cases and produced many thousands of reports. I used to accept instructions for any area of neurosurgery encountered in my clinical practice. I now limit my work to cases where I have an ongoing academic or longstanding clinical interest. These include all cases of head and spinal trauma and almost all spinal cases, such as spinal epidural haematoma, spinal infection, spinal epidural abscess, spinal cancer, and cauda equina syndrome.
Although I previously had extensive clinical and academic experience in paediatric neurosurgery, I am no longer active in this area and do not accept such cases.
In brain and spinal cases, the first step is to identify the nature and site of the pathological process. From there, I assess whether the patient was appropriately referred, whether an adequate history was taken and a proper clinical examination performed. This determines the timing and nature of investigations, including imaging.
In personal injury cases, I determine causation. In clinical negligence cases, I assess whether there was any breach of the duty of care and whether it caused or contributed to the outcome. Often, the final outcome may result from a non-negligent complication of necessary surgery. While complications in neurosurgery and spinal surgery are relatively uncommon, their consequences can be devastating.
Special Interests
I have a particular interest in cauda equina syndrome (CES). I have more scientific publications on CES than any other author worldwide and am recognised as an international authority on the subject. My work includes publications on standards of care,
clinical assessment, imaging, investigations, management, and outcomes in CES, as well as audits of medicolegal CES cases.
I also have a strong interest in spinal injury. I was the lead neurosurgeon for the NICE trauma guidelines, including the 2016 guidelines on the management of acute spinal injury. I have several academic publications related to spinal injury, including a review of secondary neurological deterioration in medicolegal spinal injury cases-the most common cause being failure to immobilise the spine.
Additionally, I have specialist interests in spinal infection and spinal epidural abscess and have published extensively in these areas.
The Essential Elements of a Good Report
At the outset, the report should explain why you are an appropriate expert for the case, using a concise mini-CV. Judges do not have time to search through a full CV to assess your credentials. I have prepared mini-CVs for each of my specialist areas, including cauda equina syndrome, spinal cord injury, traumatic head injury, brain and spinal infection, spinal vascular anomalies, subarachnoid haemorrhage, and informed consent.
The mini-CV should be placed at the front of the report, just before the introduction, so the Judge can quickly verify your expertise.
The facts of the case should be presented clearly, with any conflicts in evidence highlighted. Begin with a summary so the issues in the case are immediately apparent. Some facts must be assumed to be correct, but you should clearly state that evidence is a matter for the Court, to whom you defer.
Avoid technical jargon or explain it using footnotes or a glossary. Make life easy for the Judge. Set out the legal tests you apply: e.g., "The reasonable and responsible neurosurgeon would..." or "On balance, the outcome with surgery would have been...".
The Civil Procedure Rules require that any range of expert opinion be acknowledged. Clearly state where your opinion lies within that range and explain why. Above all, demonstrate impartiality, be measured, and explain your reasoning with reference to the medical literature.
Other Interests
I was previously an offshore yachtsman and a power pilot. I am currently training as a glider pilot.
