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A Nevada neurosurgeon told a jury Wednesday that the neck injuries he saw on a Nissan driver whose airbags allegedly misdeployed were "objectively" caused by a strong force against the forehead, despite a radiologist's differing opinion.

Nissan Airbag lawsuit Doctors

Dr. Shane Abdunnur took the stand in the trial over the injuries of John Paxin, whose loss of control of his 2012 Nissan Titan in November 2017 resulted in a catastrophic neck injury because the airbags needlessly deployed and rammed his head backward, as his lawyers have alleged in the trial, which started May 28.

Abdunnur treated Paxin at Nevada's Renown Hospital for 36 days, starting with his injury, and took the stand as a treating doctor, not an expert witness.

"In this case, do you believe John Paxin had a hyperextension injury to his cervical spine to a reasonable degree of medical probability?" Paxin's lawyer, J. Randall Jones of Kemp Jones, asked Abdunnur.

"One hundred percent yes," Abdunnur said.

"What level of confidence do you have ... based upon all the things that you reviewed and treating him, including the surgery you did on him?" Jones asked.

"John had a hyperextension injury. I don't believe it's a matter of opinion," Abdunnur said. "I think it's objective fact that's based on the objective CT scan that he had."

Abdunnur had acknowledged earlier in his testimony that the CT scan taken when Paxin had gotten to the hospital was reviewed by a radiologist who thought they were looking at a "chance fracture," a term of art from the days before shoulder seatbelts when crash victims would wrench forward and their spines would flex and also slightly distract, or pull apart.

But he said the radiologist was simply wrong.

"It is every bit of my job to know CT scans, MRIs and X-rays of the head and neck better than any radiologist, and as good or better as any neurosurgeon," Abdunnur said, calling it one of the "most fundamental components of any neurosurgeon's practice."

On cross-examination, Abdunnur acknowledged to defense lawyer Tom Klein that on medical paperwork created very shortly after Paxin arrived at the hospital, the words "chance fracture" — in other words, a flexion injury — were present. However, there was nothing about an extension or hyperextension injury.

Klein also discussed with Abdunnur that Paxin's CT scan showed two other spine conditions: ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis.

On direct examination, Abdunnur said the DISH would not have affected this injury, and that the spondylitis was "a preexisting condition that, yes, was a factor — a potential factor in his spinal cord injury." Commonly, some people with ankylosing spondylitis do not realize they have it and their reduced range of motion is what feels normal to them, he also noted.

The defense lawyer showed a picture of a flexion injury for comparison, suggesting it was quite like the CT image of Paxin's injury; Abdunnur said it was exactly opposite. Bone fragments were the result not of crushing from a head-forward flexion injury but of splitting from a head-backward extension injury, he said.

Abdunnur also said Paxin's spondylitis meant that the quality of bone that he had, and its behavior, were different from the norm.

Paxin was a retired tower crane operator and trainer who, on Nov. 8, 2017, was on his way from his home in Gardnerville to Reno, Nevada, to pick up a wheelchair as part of his volunteer work repairing wheelchairs for fellow Vietnam veterans.

However, while stopped at a light in south Carson City, Paxin had a still-unsolved medical incident and his car began to roll, drifting off the road and up and over a mild shrub-covered 20-degree slope, his lawyer said in opening arguments.

The Titan's internal computers misjudged the speed at which the car's angle was changing, thought it was rolling over, and deployed the airbags, his lawyer said.

Jones said Paxin maintained some consciousness during at least seven seconds of drifting off the road and was able to steer straight across a rocky ditch.

After 36 days in the first hospital, Paxin then did 34 days of rehab and then went back to a U.S. Department of Veterans Affairs hospital, where he spent 500 days. He moved hospitals again and again, never recovering from being paralyzed and bedbound, his lawyer said, malnourished and being fed through a tube. He incurred $6.57 million in medical bills during that time and, because of severe bedsores, could not ever progress to a wheelchair. He was able to return home to Washington state for a couple of months and passed away a little over three years after the crash, on Dec. 21, 2020, from COVID-19-related pneumonia.

"He lived a very, very, very difficult life while he remained alive," his lawyer Jones said.

Klein said it was clear that Paxin had passed out completely during the incident. The Titan drove at least 34 miles per hour over the 4½-foot-tall slope and "slammed" down, and that landing is what hurt Paxin's spine, Klein said.

"There is a great deal of dispute about what caused that neck fracture," Klein said. He said Paxin slowly went over the small slope, slammed down onto the blacktop — an entrance ramp into a Walmart shopping center — and then crossed it, hitting a curb on the other side and confusing the car's computers.

"From all data that the vehicle was able to gather, it looked like he was going to roll over," Klein said. The airbags deployed, and when he hit the curb on the other side, "that caused a sharp left steer input." The car then slowed while continuing its left turn and presently came to a stop, he said.

Paxin is represented by J. Randall Jones of Kemp Jones LLP.

Nissan is represented by Tom Klein of Klein Thomas Lee & Fresard.

The case is Paxin v. Nissan North America et al., case number A-19-805016-C, in the Eighth Judicial District Court of Nevada.