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.
