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Spinal epidural abscess misdiagnosis causes paralysis

Spinal epidural abscesses can cause dangerous spinal cord compression

A man in his 30s went to a Texas hospital emergency room (ER) three days in a row to be seen for back pain. Let’s call him Michael.

Michael was an active man who stayed busy with his family, work, and hobbies. His problem seemed to come out of the blue one day when Michael had mid-back (thoracic spine) pain. He hadn’t experienced any type of injury, so when the pain didn’t go away after a few days he went to a hospital ER to get checked out.

During his first ER visit, Michael was seen by a physician assistant (PA). Other than the back pain, the PA’s exam findings and laboratory results looked normal. The PA diagnosed him with back sprain/strain and discharged him with prescriptions for pain medication and a muscle relaxer.

The next day, Michael’s pain was worse and he had a low-grade fever. He returned to the ER and was seen by the same PA, who this time ordered a CT scan of the cervical, thoracic, and lumbar spines. There was no sign of a fracture or any acute injury on any of the scans, and the PA sent him home with a recommendation to get some rest.

By the next day, Michael’s pain level had increased again and he was still febrile (low-grade fever). He also had a headache. Michael went back to the hospital ER. This time he was seen by an ER physician who chose not to order more diagnostic imaging because Michael had just had CT scans the previous day. He was sent home with a new prescription for a more powerful painkiller.

Michael felt exasperated and went back home, filling his prescriptions and following the instructions of the PA and ER physician to get some rest. When Michael woke up the next morning, he had problems moving his legs and didn’t have control of his bladder.

His wife rushed Michael back to the ER and this time they did an MRI scan of his back. He was diagnosed with an epidural spinal abscess. Michael was rushed to the operating room to decompress the area and drain the abscess, but unfortunately because of the delayed diagnosis and treatment, Michael was left with permanent paraplegia (paralysis of his lower extremities).

What is a spinal epidural abscess?

A spinal epidural abscess is a capsule-like collection of infected fluid (pus) located between the bony vertebrae of the spine and the spinal cord—the area called the epidural space. Because there’s only limited space in the spinal canal to hold the spinal cord and nerves, a spinal epidural abscess can cause spinal cord compression.

Spinal cord compression can cut off blood flow and oxygenation and quickly cause permanent neurologic injury. That’s what happened to Michael.

Causes of spinal epidural abscess

A spinal epidural abscess is typically caused by a Staph. aureus infection, but other bacteria or fungi can cause the underlying infection. 

Risk factors include having a compromised immune system, diabetes, alcoholism, AIDS, cancer, and recent spinal procedures or epidural anesthesia.

Signs, symptoms, and diagnosis of spinal epidural abscess

Medical literature reflects that many patients with spinal epidural abscess have a “classic triad” of signs including pain, fever, and neurologic function. The diagnostic challenge is that these signs are consistent with numerous conditions. This means that the physician or ED provider needs to pay careful attention to the patient and do a thorough workup to rule out this dangerous condition.

To diagnose a spinal epidural abscess, it’s important for the physician, PA, or nurse practitioner (NP) to perform a thorough neurologic assessment. We’ve seen many cases where ER documentation of a legitimate neuro exam is shoddy or completely absent. A neuro assessment should include documentation of vision, motor and sensory function of all four extremities, coordination and balance, and mood or behavior.

Other diagnostic tools include CT scans, MRI scans, blood work, and lab analysis of a sample of cerebrospinal fluid.

Treatment

Eventually, Michael got the treatment he needed, although it was too late to prevent permanent injury.

Physicians treat a spinal epidural abscess with antibiotics to fight the underlying infection. Often, a surgeon will need to drain the fluid from the abscess capsule to relieve pressure and decompress the spinal cord. In cases such as Michael’s, where he was already having problems moving and controlling his bladder, a surgeon may need to remove the entire abscess.

A delay in treatment can cause an irreversible spinal cord injury and paralysis.

If you’ve been seriously injured by botched epidural spinal abscess care in Texas, then contact a top-rated, experienced Texas medical malpractice attorney for a free strategy session about your potential case.

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him by calling 281-580-8800 or emailing him right now.


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