Patient Experiences Permanent Paralysis Due to Missed Cauda Equina Diagnosis

Case Overview

This case involves a female patient with a medical history significant for multiple sclerosis. The patient had suffered a spinal injury after a fall while at home, after which it was discovered that she was suffering from stenosis, or narrowing, of her spinal canal. In order to treat her stenosis, the patient underwent surgery, which initially proved to be successful. However, the patient began to experience back pain shortly after surgery, which progressively worsened while she was under the care of a new physician. Eventually, imaging studies of her spine revealed suspected bone chips in her spinal canal, which appeared to have broken off from her vertebrae. Doctors eventually diagnosed her with cauda equina syndrome, however delayed surgical intervention left the woman paraplegic with little hope for recovery.

Questions to the Orthopedic Surgery expert and their responses

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

I routinely treat complicated spinal patients, such as the one described in this case. Generally speaking, Cauda equina syndrome and fragments within the spinal cord are unrelated. Of course, in this case multiple sclerosis complicates the picture. What may have happened is that the spine was left unstable and collapsed. That would put it into a grey area and the issues of negligence or malpractice would depend on the images and the records.

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

I have been fortunate to not have a patient develop the clinical sequela described in this case.

Are you able to discuss the signs and symptoms of cauda equina and the proper steps to ensure timely diagnosis?

I am able to discuss the signs and symptoms of cauda equina and the steps to ensure timely diagnosis. I maintain an active clinical practice and work at a level 1 trauma center.

About the expert

This highly qualified expert is board certified in orthopedic surgery. He earned his BS from the University of Utah and his MD from Indiana University. He completed a residency in Orthopedic Surgery at Bronx-Lebanon Medical Center before moving on to Rush-Presbyterian/St. Luke's in Chicago for his Spine Fellowship. He is fellow of the American Academy of Orthopaedic Surgeons and a Diplomate of the American Board of Orthopaedic Surgery. He has published several articles in peer reviewed journals and in addition to his busy clinical practice, he is active in the education of medical students and residents at a busy university affiliated medical center.