Laminectomy Causes Cauda Equina Syndrome

A 50-year-old male presents to his primary care physician with complaints of lower back pain for an extended time and was subsequently referred to an orthopedic for consultation at which time surgery was recommended. The surgical report states patient had a decompression and hemilaminotomy at L3-L4 and a discectomy at L4-L5. There’s a question in the surgical technique because the surgical report mentioned difficulty with a pituitary rongeur as it may have malfunctioned during the procedure. In any event, the post operative period was met with poor results as the patient now experiences bowel and bladder incontinence, sensory and motor deficits in both lower extremities, as well as foot drop. The working diagnosis by physicians was suspected cauda equina syndrome. The patient has a major loss in motor functional status after undergoing this procedure.

Question(s) For Expert Witness

1. Were the complications of this surgery due to malfunction of the surgical equipment or attributed to the surgical technique of the surgeon operating on this patient?

Expert Witness Response E-001263

Symptomatic adjacent segment disease is more likely to develop if the adjacent segment is already diseased, albeit asymptomatically, at the time of the original fusion operation. In order to avoid reoperation in this situation, it is common practice to fuse the adjacent degenerated motion segment at the same time as fusion of the symptomatic motion segment. If the degenerated adjacent segment is felt to be contributing to the patient’s pain syndrome, its fusion is further justified. By the same token, if a patient presents with significant multilevel degenerative disease, fusion should be avoided if at all possible, unless sufficient indication exists for fusion of all of the affected motion segments (eg. multilevel cervical spondylosis with myelopathy).