Myelogram Leads to Punctured Spinal Cord and Paralysis

ByMichael Talve, CEO

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Updated onOctober 10, 2017

Myelogram Leads to Punctured Spinal Cord and Paralysis

This case involves a female patient with a history of long-standing low back pain with a previous lumbar fusion performed at L3-S1. The patient was referred to the defending physician for a diagnostic myelogram and CT scan with consideration for a possible nerve stimulator. The patient sustained significant neural injury after this procedure and the plaintiff alleged that the physician entered at the incorrect level of T12-L1, which allowed the conus medullaris to be punctured. The patient experienced paralysis of the lower limbs and chronic neuropathy as a result of the procedure.

Question(s) For Expert Witness

1. When should a lumbar puncture be avoided?

Expert Witness Response E-001730

inline imageIt is important to avoid lumbar puncture in patients where the disease process has progressed to a point in which neurologic findings may be associated with impending cerebral herniation (ie, deteriorating level of consciousness and brainstem signs that include pupillary changes, posturing, irregular respirations, and very recent seizure). Cerebral herniation is the most serious complication of a lumbar puncture. It is very rare, and there is considerable debate in the literature regarding whether it is caused by the lumbar puncture or by the underlying disease process. There is increasing evidence that a diagnostic lumbar puncture is safe even in patients with increased intracranial pressure (ICP), such as most patients with meningitis, but there is no firm consensus regarding the safety of lumbar puncture in patients with ICP.

About the author

Michael Talve, CEO

Michael Talve, CEO

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.

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