Orthopedic Surgery Expert Witness Opines on Spinal Surgery

This case involves a fifty-five-year-old male who underwent an anterior and posterior spinal fusion surgery for the treatment of an epidural abscess with spinal cord compression. According to the medical record, the procedure was conducted without incident, however, the patient sustained deleterious, long-term complications due to a severe infection of the surgical site including wound dehiscence. The patient required a re-exploration of the spinal fusion that involved the repositioning of a pedicle screw that was not secured during the original procedure. The patient also required several irrigation and debridement procedures to heal the wound. A stage IV pressure sacral ulcer also developed during his stay at the hospital and the development of erectile dysfunction that was not resolved.

Question(s) For Expert Witness

1. What management changes could have led to a better outcome for this patient?

Expert Witness Response E-007068

A spinal epidural abscess threatens the spinal cord or cauda equina by compression and also by vascular compromise. If untreated, an expanding suppurative infection in the spinal epidural space impinges on the spinal cord, producing sensory symptoms and signs, motor dysfunction, and, ultimately, paralysis and death. Intervention early in the course of the disease undoubtedly improves the outcome. Frequently, diagnosis is delayed because the initial presentation may be only nonspecific back pain. One half of cases are estimated to be misdiagnosed or have a delayed diagnosis but prompt treatment can lead to better outcomes for such patients.