Spine and Spinal Cord Malpractice Cases
Spine and spinal cord malpractice lawsuits tend to involve either a mistake made in orthopedic surgery or the failure to diagnose a serious problem. Below are some of the most common examples we’ve seen in our law practice. Click here to return to our main medical malpractice page.
Misdiagnosed Spinal Epidural Abscess Malpractice
A spinal epidural abscess happens when there’s swelling and inflammation near the spinal cord. Typically, the swelling is caused by a bacterial infection, like MRSA or other staph infections, that has entered the epidural space around the spine. That swelling can compress the spinal cord, leading to severe and permanent injuries, including paralysis. Sometimes, the staph infection made it into the epidural space as the result of an injury, trauma, surgery, or an injection. Many spinal abscesses are caused by improper injections, such as spinal taps taken without sterilizing the surface of the skin or injections of steroids or pain killers that are made too close to the spine.
As an article in the New England Journal of Medicine noted more than a decade ago, “Spinal epidural abscesses are often initially misdiagnosed, particularly in neurologically intact patients.” That’s what we see in our cases: doctors fail to diagnose a spinal abscess in a surprising number of cases. Doctors will often thoroughly investigate every other possibility — including through the use of exploratory surgery — before they suspect an abscess. Unfortunately, many doctors, including even emergency medicine physicians and neurologists, assume that patients can’t have an epidural abscess without the “clinical triad” of back pain, fever, and neurological deficit. Only a small fraction of patients with a spinal epidural abscess will have all of those symptoms.
In reality, any patient with suspicion of an infection (whether because of a fever, an elevated white blood count, an infection or cyst elsewhere on their body, if they had pneumonia, or if they have recently taken an antibiotic) and neurological symptoms like pain, tingling, or weakness should be evaluated for a spinal epidural abscess.
Similarly, doctors often wrongly believe that a lumbar puncture will give them a definitive answer. Medical studies have shown that lumbar punctures are rarely useful in this context and that the best way to rule out a spinal epidural abscess is to perform a CT or MRI of the spine and the abdominal area.
Once a spinal epidural abscess is discovered, the treatment needs to be immediate. Sometimes, if it is caught early, IV antibiotics with close monitoring is sufficient. But, if the patient has any signs of neurological injury, like bowel or bladder dysfunction, then the abscess will need to be drained immediately. Often, the patient will need an emergent spinal decompression to save the spinal cord from further damage.
Orthopedic Surgery Mistakes
More than 500,000 Americans undergo surgery every year for low back problems alone. These procedures are very profitable for orthopedic surgeons and hospitals, and studies have shown that more than $500 million a year is spent on unnecessary back surgeries. Millions of dollars are spent on advertisements for spondylolysis surgeries, even though there is little evidence that they improve patient’s lives, and no clear guidelines for when they should be used. Even worse, many of these procedures are done improperly, causing catastrophic injuries. A review of spinal surgery malpractice lawsuits found the most common cause for a lawsuit was “improper performance.”
Every type of spinal surgery — cervical fusion, decompression, and lumbar laminectomy — puts at risk the spinal column, spinal cord, and the nerves that connect the spinal cord to the rest of the body. Similarly, all spinal surgeries require a patient be put under general anesthesia, which comes with a risk of respiratory complications, brain damage from hypoxia, and death.
In our experience, most orthopedic surgery malpractice involves at least one of the following:
- Negligent surgical management: During a spinal surgery, a patient’s vital signs are monitored closely, but there are two other issues that require constant attention. First, an electronic system (called neuromonitoring) is used to monitor the signals coming from and going to the spinal cord, and any disruption in those signals is cause for immediate concern, and often a change in the operation. Second, given how extensive spinal surgery is, anesthesiology monitoring, such as for blood loss and proper oxygenation, can mean the difference between a successful operation and severe injuries including blindness or a stroke. For example, allowing a patient to become dehydrated during an operation dramatically increase the risk of a stroke.
- Operating blind: There is an old saying in surgery, “don’t cut what you can’t visualize.” The meaning of this phrase is simple: if a surgeon can’t see what they are doing, they shouldn’t assume they are doing it right. Many parts of an operation involve a surgeon implanting a product (like spinal screws) or cutting tissue (like adhesions) with low visibility, and many surgeons, in a hurry to get through the operation and go to the next case, simply assume they are performing the procedure correctly. But every person’s anatomy is different, and the surgery itself moves organs and tissue around in the body. Moreover, an error in the surgery doesn’t have to mean permanent injury for the patient: many times, a simple CT scan can show what has happened and reveal how to fix it, but such a repair has to be done immediately to prevent permanent injuries like nerve damage.
- Operating on patients with comorbidities: Spinal surgery is invasive and prolonged. Because of that, the orthopedic surgeon must pay careful attention to whether or not the patient will be able to tolerate the procedure. Many malpractice cases involve orthopedic surgeons who operated on patients with diabetes, morbid obesity, hypertension, sleep apnea, or coronary disease without first getting clearance from other specialists, like a cardiologist or a pulmonologist. In many cases, it is not enough for a surgeon to simply review the results of EKG or stress testing themselves.
Failure To Diagnose Burst Fractures: A “burst fracture” occurs when a vertebrae is compressed or crushed by trauma, such as a fall from a height or a car accident. The difference between a “burst fracture” and a “compression fracture” comes from the shape of the vertebrae after the injury: if the vertebrae is crushed towards the front, it’s a compression fracture, but if it’s crushed all around, it’s a burst fracture. Burst fractures are far more dangerous because the fracture can bruise or sever the spinal cord, causing paralysis or injuries to the nerves. Additionally, burst fractures tend to be “unstable,” meaning they are more likely to progress further.
Unfortunately, many times burst fractures are misdiagnosed as compression fractures or as degenerative disc disease, and after that misdiagnosis the patient is often discharged from the hospital before a surgery and without any efforts to stabilize their spine. That puts the patient at great risk, because the burst fracture can get worse at any time, and, when it does, it can injure the spinal cord, causing permanent injury.
Undiagnosed Spinal Tumors
Spinal cord tumors come in several types, but they produce similar symptoms, including:
- back pain that prevents sleeping
- muscle weakness or numbness in arms or legs, and
- bladder or bowel trouble.
Many medical conditions can cause these same conditions, which it is why doctors need to order an MRI to rule out the possibility of a tumor. A single MRI can reveal the difference between ordinary chronic back pain and a spinal tumor that needs surgery, but family doctors and emergency rooms are often dismissive of these issues and so put the patient at risk. It is common for patients to go months, sometimes years, before their spinal tumors are properly diagnosed by MRI, with devastating results, including paralysis and metastasis into cancer. Sometimes, however, the MRI is misread by the radiologist, delaying treatment.