This case involves a sixty-year-old female patient that was having extreme lower back pain that prompted a visit to her family doctor for an evaluation. Twenty years earlier, the patient had previous back surgery to the L3-L4 spine. The patient was referred to an orthopedic physician who performed an L2-L3 spinal fusion, and revision of the L3-L4 spinal fusion, a L4-L5 spinal fusion, and an L5 laminectomy. The operative note stated that all phases of the procedure were conducted without incident, but the patient complained of massive pain, postoperatively. Five days later, the patient received a CT scan that showed an epidural hematoma that spread to the thoracic portion of the spine. The patient now has a foot drop, lower back pain, and other neurological issues as a result of the delayed treatment.
Question(s) For Expert Witness
1. Could an earlier intervention have prevented this outcome?
Expert Witness Response E-004835
Although several recent reports have described successful conservative management of epidural hematoma, surgical evacuation constitutes definitive treatment of this condition. Immediate laminectomy followed by evacuation of the hematoma would have been warranted here. This would be followed by coagulation of bleeding sites and inspection of the dura. The dura is then tented to the bone and, occasionally, epidural drains are employed for as long as twenty-four hours.
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.
