Discectomy Gone Wrong Causes Spinal Stenosis, Cauda Equina, and Foot Drop

This case involves a 48-year-old male who underwent a micro-discectomy at L3-L4. Immediately following the procedure, the patient experienced numbness in his legs along with the inability to void his bladder. An MRI was performed the day after surgery and revealed a large extradural defect at L3-L4 juncture, which was consistent with a large central disc herniation. A second surgery was performed the following day that revealed a calcified annulus with resultant stenosis and compression of the thecal sac. The second surgery did not relieve that patient’s symptoms and he is currently non-ambulatory and wheelchair bound. The final diagnosis was severe cauda equina with foot drop.

Question(s) For Expert Witness

1. Are these complications a known risk for surgery?

Expert Witness Response E-004741

I would suspect that the manipulation during surgery was responsible for the deficits, which could imply negligence. Failed back syndrome (FBS), also called "failed back surgery syndrome" (FBSS), refers to chronic back and/or leg pain that occurs after spinal surgery. Multiple factors can contribute to the onset or development of FBS. Contributing factors include residual or recurrent disc herniation, persistent post-operative pressure on a spinal nerve, altered joint mobility, joint hypermobility with instability, scar tissue or fibrosis, depression, anxiety, sleeplessness and spinal muscular deconditioning. An individual may be predisposed to the development of FBS due to systemic disorders such as diabetes, autoimmune disease, and vascular disease.