In the days following any spinal surgery, the surgeon and nursing staff must be vigilant about watching for signs of a hematoma developing and putting pressure on to the patient’s spinal cord.
A hematoma is a solid collection of clotted blood. Hematoma sometimes form following a spinal surgery, and orthopedic and neurosurgical experts often refer to them as a compressive lesion. There is only a limited amount of space in the spinal canal; thus, if a hematoma forms there, it can compress the spinal cord.
I am currently working on a case for a patient who had lumbar spine surgery at a northwest Houston/ Willowbrook area hospital. For the first day and a half after his surgery, his condition was fine.
The first sign of trouble was when the nurses documented that his dorsiflexion and plantar flexion in both legs were weak. Dorsiflexion is bending the foot up toward the head. Plantar flexion is bending the foot down away from the head.
Next, the nurses noted that his bladder was full, but he was unable to void the urine. They inserted a straight catheter and partially drained his bladder.
Both of these findings are significant neurologic signs for a patient that just went through spinal surgery. The standard of care requires the nursing staff to notify the surgeon immediately and advocate for orders and physician care of the patient.
Unfortunately, the nurses waited almost eight hours before paging the surgeon. When the surgeon returned the call about 30 minutes later, the nurses only reported numbness from the waist down to his feet and inability to void urine. There is no reference to discussing his abnormal dorsiflexion and plantar flexion. The surgeon ordered a routine MRI and re-insertion of a Foley catheter to address the urinary retention problem.
Symptoms of spinal cord compression
Generally speaking, symptoms of spinal cord compression include numbness, pain, and weakness.
In the lumbar region, spinal cord compression can cause more serious symptoms known as cauda equina syndrome. The symptoms include the loss of bowel and/or bladder control; numbness between the legs, inner thighs, and back of the legs; severe pain and weakness that spreads into one or both legs; difficulty walking; and difficulty getting out of a chair.
With any of the symptoms present, particularly in a patient who had recently undergone lumbar spine surgery, the standard of care requires an order for a stat MRI to rule out a hematoma. If the MRI reveals a hematoma, the standard of care typically requires the orthopedic surgeon or neurosurgeon to return the patient to surgery as soon as possible to decompress the spinal cord to relieve the damaging pressure.
A stat MRI is performed as soon as possible, which, at most hospitals, is typically within an hour. A routine MRI, which is what the surgeon ordered in the case I am currently working on, may take many hours, depending on how busy the radiology department as of the time.
In my client’s case, there was a delay of almost eight hours from the first sign of a neurologic problem to nursing notification of the surgeon. From that point, there was a delay of over seven hours before the surgeon came to see the patient. By that time, incredibly, the routine MRI had not been done. Even more incredibly, despite the patient’s worsening neurologic status, the surgeon chose to cancel the MRI altogether.
Delay in treating spinal cord compression
When a patient has any signs and symptoms of spinal cord compression, it requires immediate physician or surgical attention. That is why the standard of care requires the nursing staff to immediately notify the surgeon of such findings, and for the surgeon to order stat imaging, like MRI, to allow rapid treatment of any compression lesion.
Prolonged spinal cord compression often leads to permanent injuries. When spinal cord compression in the lumbar area is not promptly treated, it can lead to a permanent condition called cauda equina syndrome.
Experts have found that cauda equina syndrome can develop acutely (quickly) or gradually.
Signs and symptoms of acute onset of cauda equina syndrome include severe low back pain and significant loss of bladder and bowel function, followed by sensory and motor deficits below the waist.
When cauda equina syndrome is gradually developing, signs and symptoms develop and progress over several weeks or months. These typically include partial or temporary (coming and going) loss of bladder and bowel function, incontinence, or dysfunction; pain in the lower back: muscle weakness; and numbness.
Unfortunately, my client was discharged from the hospital with all of the symptoms and still suffers from them several months later. While the nursing staff documented at least parts of his various signs and symptoms of cauda equina syndrome, the physicians never acknowledged or treated his condition. The spinal surgery expert that our law firm retained to review the case has informed us that his disabilities are now permanent.
What you can do
If you or someone you care for is hospitalized and you notice concerning neurologic symptoms, it is important to speak up to your nurse and to insist on seeing your doctor or surgeon. If the nurse seems unconcerned, ask to see the charge nurse, which is a nursing supervisor. The old saying says that the squeaky wheel gets the grease, and this often applies in busy hospital settings.
The experienced medical malpractice attorneys at Painter Law Firm, in Houston, Texas, are here to help. For a free evaluation of your potential case, call us at 281-580-8800.
Robert Painter is an attorney at Painter Law Firm PLLC, in Houston, Texas, where he focuses his practice on medical malpractice cases. He represents patients and their families and medical negligence and wrongful death lawsuits against surgeons, doctors, and hospitals, like Houston Methodist Willowbrook Hospital, CHI St. Luke’s Health The Vintage Hospital, Houston Northwest Hospital, and Tomball Regional Medical Center.