Neurosugeon Opines on Delayed Treatment of Cauda Equina Syndrome

Case Overview

This case involves a patient who presented to the emergency room with cauda equina syndrome. There was one neurosurgeon on-call, but the physician did not report to the hospital for over 24 hours after being informed of the patient’s condition. Upon his arrival, the physician did not order an MRI or any other immediate treatment. The ER did not have MRI facilities on site on weekends, and no arrangements were made for the patient to undergo imaging elsewhere. The patient ultimately underwent surgery four days later at a different institution, well after the optimal window of treatment for patients with cauda equina syndrome had passed. An expert in neurosurgery is required to help determine whether there was a deviation from the standard of care.

Questions to the Neurosurgery expert and their responses

Do you routinely treat patients similar to the one described in the case?

I have 20 years of experience practicing neurosurgery in academic and veterans hospitals. I have evaluated and operated on numerous patients with cauda equina syndrome.

Have you ever had a patient develop the outcome described in the case?

I have consulted on cases before that involved delayed treatment of pressure on spinal nerves or the spinal cord that resulted in permanent deficits.

Do you believe there may have been a deviation in the standard of care that contributed to this patient's poor outcome?

It appears that the patient failed to receive timely neurosurgical intervention that might have prevented or reduced any subsequent permanent neurologic deficit.

About the expert

This highly qualified Neurosurgery expert received his medical degree from the highly regarded Yale University School of Medicine and went on to complete postgraduate training at the prestigious University of Pennsylvania. He is board certified by the American Board of Neurological Surgery and is a member of numerous professional organizations including the Congress of Neurological Surgeons. He has published 49 peer-reviewed journal articles and authored 10 books and book chapters in his field. His research projects have attracted over a million dollars in funding, and he is frequently invited to lecture as a guest speaker at engagements throughout the country. He currently holds academic, administrative and clinical appointments at an ivy league university.