Orthopedic Surgery Expert Evaluates Delayed Diagnosis of Cauda Equina

This case involves a middle aged man who was diagnosed with cauda equina syndrome. The Plaintiff had a history of chronic back pain, and during a visit to his primary care doctor he received a referral to an orthopedic spine surgeon for evaluation and possible treatment. After seeing the Plaintiff, the orthopedic surgeon recommended surgery to relieve pressure on the Plaintiff’s spinal cord, which was then performed without complications. Some time after the procedure, the Plaintiff sat down while at home and immediately experienced extreme pain as well as a progressive numbness in his legs. After contacting his orthopedic surgeon, the Plaintiff was told that the issue was likely caused by swelling from the surgery, and he was instructed to call back later if his symptoms did not subside. Some time later, the Plaintiff noted that the pain and numbness had continued, and that he would need a refill of his painkillers. During this second call, the Plaintiff also noted that he was having difficulty voiding his bowels and bladder. Despite these complaints, the orthopedic surgeon continued to insist that the cause was residual swelling from the surgery. Later, the Plaintiff was diagnosed with cauda equina by a second doctor, which caused a permanent loss of function and sensation in his lower body.

Question(s) For Expert Witness

1. Do you have extensive experience treating patients who are suffering from cauda equina?

2. Are you familiar with the proper steps and protocols to follow when treating a patient who presents with these symptoms?

Expert Witness Response E-007022

Obviously cauda equina syndrome is a serious condition and patients are certainly at risk for permanent neurologic deficits when it arises, so a timely diagnosis is critical. For a complete understanding of how this outcome was reached, it is important to ask when his symptoms started, when the diagnosis of cauda equina was established, how soon surgery was performed once it was discovered, and whether or not his symptoms improved after surgery. The delay in original diagnosis here despite the patient's repeated concerns about pain and numbness leads me to believe that the follow up here was not appropriate. Once cauda equina is established beyond a doubt, it is commonly accepted that surgery must be performed within 24-48 hours in order to relieve pressure on the nerves and prevent permanent damage. Given what appear to be permanent neurologic deficits including incontinence, it is worthwhile to look into this matter closely from a malpractice perspective. I am a board-certified orthopaedic surgeon who is fellowship-trained in orthopaedic and neurosurgical spine surgery. I am currently an Associate Professor at a major medical center associated with an ivy league medical school.