Patient Experiences Permanent Paralysis Due to Missed Cauda Equina Diagnosis

This case involves a female patient with a medical history significant for multiple sclerosis. The patient had suffered a spinal injury after a fall while at home, after which it was discovered that she was suffering from stenosis, or narrowing, of her spinal canal. In order to treat her stenosis, the patient underwent surgery, which initially proved to be successful. However, the patient began to experience back pain shortly after surgery, which progressively worsened while she was under the care of a new physician. Eventually, imaging studies of her spine revealed suspected bone chips in her spinal canal, which appeared to have broken off from her vertebrae. Doctors eventually diagnosed her with cauda equina syndrome, however delayed surgical intervention left the woman paraplegic with little hope for recovery.

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?

3. Are you able to discuss the signs and symptoms of cauda equina and the proper steps to ensure timely diagnosis?

Expert Witness Response E-018598

I routinely treat complicated spinal patients, such as the one described in this case. Generally speaking, Cauda equina syndrome and fragments within the spinal cord are unrelated. Of course, in this case multiple sclerosis complicates the picture. What may have happened is that the spine was left unstable and collapsed. That would put it into a grey area and the issues of negligence or malpractice would depend on the images and the records. I have been fortunate to not have a patient develop the clinical sequela described in this case. I am able to discuss the signs and symptoms of cauda equina and the steps to ensure timely diagnosis. I maintain an active clinical practice and work at a level 1 trauma center.