Neurosurgery Expert Opines on Delayed Care Leading to Paraplegia

Case Overview

This case involves a female Plaintiff who injured her back while working in a shipping and receiving center. She presented to her primary care physician complaining of significant pain and was prescribed painkillers and sent home. Over the course of the next few days, the patient complained of worsening pain in her lower back, which had now begun to radiate to her thighs. She returned to her doctor, with additional complaints of difficulty urinating. She was sent for an MRI, which revealed a number of compressed disks in her lower back and a narrowing of her spinal canal. Despite this discovery, the patient was not referred to a neurosurgeon for an extended period of time, and her numbness eventually progressed to permanent paraplegia.

Questions to the Neurosurgery expert and their responses

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

I am a fellowship-trained spine surgeon working at a level II trauma center, so I frequently see spine fractures and spine injuries with neurologic deficits.

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

Typically, I have seen patients develop these deficits immediately after the injury. In this case, I believe there was a delay in care, especially given that she had worsening symptoms with MRI findings of severe stenosis. Typically, treatment would have been initiated then rather than waiting until the deficits became worse. My initial thoughts are that the patient should have had imaging done at the time of the injury, with at least X-rays to rule out fractures. Assuming those would have shown the fractures, she should have received an MRI at that time specifically to look for critical compression / stenosis of the canal. Based on the imaging and the patient's symptoms at the time it might have been reasonable to treat conservatively initially. However, when the symptoms progressed, she should potentially have been at least referred to neurosurgery then, if not underwent surgery.

About the expert

This board certified neurosurgeon earned a BA and MD from Northwestern University. He completed residency training in neurosurgery at SUNY Upstate Medical University and fellowship training in orthopedic and neurosurgical spine surgery at the New England Baptist Hospital at Tufts University School of Medicine. He is a member of both the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. Currently, this expert is a privately practicing neurosurgeon focusing on the spine.

E-009415

Specialties:

Neurosurgery