Unrecognized Spinal Defect Causes Neurological Damage Following Surgery

This case involves a middle aged patient who had unrecognized Spina Bifida Occulta prior to a surgery. The orthopedic surgeon performed a fusion which missed a defect in the patient’s spine. The patient had a bony defect at the S1 level that was 1-2 cm in size, and during exposure, the neural structures were damaged. As a result of this oversight, the plaintiff now suffers from Cauda equine syndrome. This patient now endures from permanent neurologic damage as a result of the fusion surgery.

Question(s) For Expert Witness

1.) Can a patient have Spina Bifida Occulta which goes unrecognized in pre-work up for a spinal surgery?

2.) How recognizable is Spina Bifida Occulta during spinal surgery?

Expert Witness Response E-000720

Spina bifida occulta is one of the most common congenital deformities found in the adult spine, occurring in about 10% to 20% of Caucasian adults. It is usually asymptomatic unless there are other associated abnormalities, i.e. spondylolisthesis. Because of its high prevalence in adults, it must be ruled out before any open posterior lumbar or sacral surgery. A defect of 1 to 2 cm should be readily apparent on routine AP lumbar x-rays. Hence routine lumbar x-rays are taken preoperatively before any posterior open surgical procedure. If there is any doubt regarding smaller defects, they will be apparent on CT scanning. Lumbar MRI is the least sensitive modality of diagnosis, as this modality is more sensitive to soft tissue and least sensitive to cortical bone.