Overlooked Medication Interaction Causes A Patient Permanent Paralysis

Case Overview

This case involves an elderly female patient who received a translaminar epidural steroid injection in the cervical spine while taking aspirin. During her consultation with the physiatry physician, the patient was not consulted regarding her aspirin use and was not told that aspirin use posed any risks to her. Within a few hours of the injection, the patient developed a large hematoma in the cervical spine causing compression. Following emergency decompression surgery, the patient became paralyzed from the waist down. It was alleged that the physician failed to provide the patient with informed consent prior to the injection. An expert physiatrist with experience performing translaminar epidural steroid injections was sought to opine on whether the defendant physician fell below the standard of care.

Questions to the Orthopedics expert and their responses

How often do you currently perform translaminar epidural steroid injections in the spine?

I perform cervical interlaminar epidural steroid injections regularly -- approximately 3-4 times per week.

Should a patient be warned of the dangers of receiving this injection while taking aspirin?

In my opinion, aspirin carries a small increased risk of a potentially catastrophic complication of cervical epidural hematoma with neurological injury and patients should be warned of this such that shared decision making can ensue. In cases where aspirin is used as primary prophylaxis (i.e. no prior cardiovascular event, such as stroke or heart attack) or when aspirin was not prescribed by a physician. That being said, US guidelines prior to 2015 did not clearly endorse cessation of aspirin prior to accessing the epidural space.

About the expert

This expert completed his BA at University of Colorado, Boulder and his MD at Oregon Health and Science University School of Medicine. He finished his internship and residency in physical medicine and rehabilitation at University of Washington before completing his fellowship in pain medicine at University of Colorado. He is board certified in physical medicine and rehabilitation, pain medicine and sports medicine. Currently, he is an assistant professor of physical medicine and rehabilitation, an associate fellowship director in pain management, and an attending physiatrist at a CO university.