Laminectomy Causes Cauda Equina Syndrome

Case Overview

A 50-year-old male presents to his primary care physician with complaints of lower back pain for an extended time and was subsequently referred to an orthopedic for consultation at which time surgery was recommended. The surgical report states patient had a decompression and hemilaminotomy at L3-L4 and a discectomy at L4-L5. There’s a question in the surgical technique because the surgical report mentioned difficulty with a pituitary rongeur as it may have malfunctioned during the procedure. In any event, the post operative period was met with poor results as the patient now experiences bowel and bladder incontinence, sensory and motor deficits in both lower extremities, as well as foot drop. The working diagnosis by physicians was suspected cauda equina syndrome. The patient has a major loss in motor functional status after undergoing this procedure.

Questions to the Neurosurgery expert and their responses

Were the complications of this surgery due to malfunction of the surgical equipment or attributed to the surgical technique of the surgeon operating on this patient?

Symptomatic adjacent segment disease is more likely to develop if the adjacent segment is already diseased, albeit asymptomatically, at the time of the original fusion operation. In order to avoid reoperation in this situation, it is common practice to fuse the adjacent degenerated motion segment at the same time as fusion of the symptomatic motion segment. If the degenerated adjacent segment is felt to be contributing to the patient’s pain syndrome, its fusion is further justified. By the same token, if a patient presents with significant multilevel degenerative disease, fusion should be avoided if at all possible, unless sufficient indication exists for fusion of all of the affected motion segments (eg. multilevel cervical spondylosis with myelopathy).

About the expert

This highly qualified expert is in practice, and is board certified in neurological surgery. He has been appointed to several hospital and academic faculty positions, and has been published over 40 surgical publications throughout his career. His qualifications make him extremely capable of reviewing this case.

E-001263

Specialties:

Neurosurgery

Michael Talve stands at the forefront of legal innovation as the CEO and Managing Director of Expert Institute. Under his leadership, the Expert Institute has established itself as a vital player in the legal technology arena, revolutionizing how lawyers connect with world-class experts and access advanced legal technology. Michael's role involves not only steering the company's strategic direction but also ensuring the delivery of unparalleled intelligence and cutting-edge solutions to legal professionals. His work at Expert Institute has been instrumental in enhancing the capabilities of attorneys in case preparation and execution, making a significant impact on the legal industry's approach to expert consultation and technological integration. Michael's vision and execution have positioned the Expert Institute as a key facilitator in the intersection of law and technology.