This case involves an elderly female patient who received a translaminar epidural steroid injection in the cervical spine while taking aspirin. During her consultation with the physiatry physician, the patient was not consulted regarding her aspirin use and was not told that aspirin use posed any risks to her. Within a few hours of the injection, the patient developed a large hematoma in the cervical spine causing compression. Following emergency decompression surgery, the patient became paralyzed from the waist down. It was alleged that the physician failed to provide the patient with informed consent prior to the injection. An expert physiatrist with experience performing translaminar epidural steroid injections was sought to opine on whether the defendant physician fell below the standard of care.
Question(s) For Expert Witness
1. How often do you currently perform translaminar epidural steroid injections in the spine?
2. Should a patient be warned of the dangers of receiving this injection while taking aspirin?
Expert Witness Response E-086595
I am a board-certified professor in physical medicine and rehabilitation as well as an associate fellowship director in pain medicine. I perform cervical interlaminar epidural steroid injections regularly -- approximately 3-4 times per week. In my opinion, aspirin carries a small increased risk of a potentially catastrophic complication of cervical epidural hematoma with neurological injury and patients should be warned of this such that shared decision making can ensue. In cases where aspirin is used as primary prophylaxis (i.e. no prior cardiovascular event, such as stroke or heart attack) or when aspirin was not prescribed by a physician. That being said, US guidelines prior to 2015 did not clearly endorse cessation of aspirin prior to accessing the epidural space.
About the author
Wendy Ketner, M.D.
Dr. Wendy Ketner is a distinguished medical professional with a comprehensive background in surgery and medical research. Currently serving as the Senior Vice President of Medical Affairs at the Expert Institute, she plays a pivotal role in overseeing the organization's most important client relationships. Dr. Ketner's extensive surgical training was completed at Mount Sinai Beth Israel, where she gained hands-on experience in various general surgery procedures, including hernia repairs, cholecystectomies, appendectomies, mastectomies for breast cancer, breast reconstruction, surgical oncology, vascular surgery, and colorectal surgery. She also provided care in the surgical intensive care unit.
Her research interests have focused on post-mastectomy reconstruction and the surgical treatment of gastric cancer, including co-authoring a textbook chapter on the subject. Additionally, she has contributed to research on the percutaneous delivery of stem cells following myocardial infarction.
Dr. Ketner's educational background includes a Bachelor's degree from Yale University in Latin American Studies and a Doctor of Medicine (M.D.) from SUNY Downstate College of Medicine. Moreover, she is a member of the Board of Advisors for Opollo Technologies, a fintech healthcare AI company, contributing her medical expertise to enhance healthcare technology solutions. Her role at Expert Institute involves leveraging her medical knowledge to provide insights into legal cases, underscoring her unique blend of medical and legal acumen.
