Neurosurgery Expert Opines on Delayed Care Leading to Paraplegia

This case involves a female Plaintiff who injured her back while working in a shipping and receiving center. She presented to her primary care physician complaining of significant pain and was prescribed painkillers and sent home. Over the course of the next few days, the patient complained of worsening pain in her lower back, which had now begun to radiate to her thighs. She returned to her doctor, with additional complaints of difficulty urinating. She was sent for an MRI, which revealed a number of compressed disks in her lower back and a narrowing of her spinal canal. Despite this discovery, the patient was not referred to a neurosurgeon for an extended period of time, and her numbness eventually progressed to permanent paraplegia.

Question(s) For Expert Witness

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

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

Expert Witness Response E-009415

I am a fellowship-trained spine surgeon working at a level II trauma center, so I frequently see spine fractures and spine injuries with neurologic deficits. Typically, I have seen patients develop these deficits immediately after the injury. In this case, I believe there was a delay in care, especially given that she had worsening symptoms with MRI findings of severe stenosis. Typically, treatment would have been initiated then rather than waiting until the deficits became worse. My initial thoughts are that the patient should have had imaging done at the time of the injury, with at least X-rays to rule out fractures. Assuming those would have shown the fractures, she should have received an MRI at that time specifically to look for critical compression / stenosis of the canal. Based on the imaging and the patient's symptoms at the time it might have been reasonable to treat conservatively initially. However, when the symptoms progressed, she should potentially have been at least referred to neurosurgery then, if not underwent surgery. I work at several level II trauma centers in which I frequently see spine fractures both with and without neurological deficits, and am familiar with both surgical and non-surgical treatment options.