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Spinal Epidural Abscess Misdiagnosis

Spinal Epidural Abscess Misdiagnosis

Spinal epidural abscess (“SEA”) is a bacterial infection in the spinal canal which, if not promptly diagnosed and treated, can result in paralysis or even death. Bacteria enters the epidural space resulting in abscess formation and damage to the spinal cord due to either direct compression of the cord or interruption of the blood supply (ischemia). Spinal cord compression or ischemia is a medical emergency which requires immediate intervention.

The “classic triad” of symptoms for a spinal epidural abscess is back pain (present in 75% of SEA cases), fever (48%), and neurologic deficits like motor weakness (33%).

It is relatively uncommon for a patient to have all three symptoms on initial presentation to a doctor, but where this occurs, the physician must have a high index of suspicion for a spinal epidural abscess.

Blood tests and cultures provide helpful diagnostic information, but where there is a concern for spinal epidural abscess, patients should undergo an immediate MRI of the spine (or CT scan of the spine with IV contrast, if MRI is unavailable) to look for evidence of an infectious mass in the spinal canal.

When imaging reveals a spinal epidural abscess, the standard of care requires emergency neurosurgical consultation for likely surgical decompression of the spinal cord and nerve roots.

The faster this can be accomplished, the greater the chance that permanent neurologic injury can be avoided, or at least minimized.

If the disease process progresses untreated, the neurologic deficits progress to include urinary retention, bowel incontinence, and progressive motor and sensory deficits culminating in paralysis, which may be permanent if surgical intervention does not occur quickly enough.

A physician has likely violated the applicable standard of care if a patient presents with the classic triad of symptoms and the physician fails to suspect spinal epidural abscess and order the appropriate diagnostic tests.

This is especially true where the patient has a risk factor for SEA, the most common of which is diabetes mellitus (present in 33% of all SEA cases). Recent instrumentation of the epidural space during lumbar puncture or epidural catheterization is another important risk factor as well.

Although spinal epidural abscess is an uncommon diagnosis, its incidence has unfortunately been increasing in recent years.

The following is a typical fact pattern in medical malpractice cases concerning a delay in diagnosis of spinal epidural abscess:

A patient presents to an emergency room with a recent onset of progressively worsening back pain, a fever, and leg or arm weakness, but the patient is either admitted to the hospital or discharged from the ER with an incorrect diagnosis. However, the patient’s neurologic condition progressively deteriorates without any recognition of the deterioration or its significance.

In a matter of two to three days, the patient has suffered a severe and irreversible spinal cord injury, leaving the patient permanently disabled. Such patients often lose the ability to work or even live independently, requiring skilled nursing or other assistance for the most basic activities of daily living (ADLs).

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The attorneys at Youman Caputo have considerable experience handling claims involving a delay in diagnosis of spinal epidural abscess. They work with highly qualified medical experts in fields including neurosurgery and infectious disease to investigate potential cases and, where the medical evidence reveals that a patient has suffered a disabling spinal cord injury as a result of a negligent delay in diagnosis of spinal epidural abscess, Youman & Caputo litigates the case aggressively to seek the maximum compensation available under the law.

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