Clinical negligence claims following spinal injuries usually occur when a patient’s surgery has been performed negligently, or there is a delay in diagnosis of a back injury that leads to further damage.

The spine is the key component of the central nervous system and any damage or interruption to this system can have very serious consequences, such as paralysis.

Common spinal surgery includes discectomy and laminectomy and damage can be done in a number of ways. There are several reported cases of surgeons operating on the wrong level of vertebrae and even removing the wrong disc. This can cause serious nerve injuries and result in paraplegia.

Any clinical negligence investigation should examine the precise reason that the injury occurred, including the possibility that the injury was caused by surgical error.

CAUDA EQUINA SYNDROME

Spinal injuries may also occur when an injury is not diagnosed or treated in a timeframe that facilitates a positive outcome.

Cauda equina syndrome occurs where the nerves at the base of the spine are compressed by pressure, sometimes caused by a slipped or prolapsed disc. This can lead to pain and loss of sensation around the abdomen and legs.

Cauda equina syndrome is often misdiagnosed as a lesser injury such as a pulled back muscle. However, the consequences of delay in treatment of this condition can be severe and lead to permanent nerve injury. Amongst other conditions, this can cause foot drop, saddle anaesthesia and bladder and bowel incontinence.

In assessing whether a patient may have cauda equina syndrome, a doctor should lookout for any of the following symptoms:

  • Lower back pain which is more tender when pressure is applied
  • Pain in the legs or pain which radiates to the legs
  • Loss of sensation around the pelvis and buttocks
  • Change in bladder or bowel function

Whilst any of these symptoms may be caused by other, less serious conditions, the presence of any one of these should alert a doctor to the possibility of cauda equina syndrome which can be diagnosed using a number of tests including MRI and CT scans.

If you would like to discuss a potential claim with one of our specialist lawyers please contact us for a free initial consultation.


RELEVANT CASES

TD v GLOUSTERSHIRE HOSPITAL NHS FOUNDATION TRUST

Geldards LLP was instructed to being a claim against the above named Trust following one month delay in diagnosis and treatment of right hip fracture.

On 24th May 2008 the Claimant attended the Accident & Emergency Department of the hospital having started to experience severe back pain earlier that day. He had been seen by a General Practitioner who had advised that he should go directly to hospital.

The Claimant arrived at hospital at 15:59 hours and after a considerable wait he was seen and examined by a doctor. He gave a history of severe back pain and weakness and numbness affecting both legs. He had no bladder or bowel problems and on examination, tone in his legs was normal but power in his hips and knees was falling to 5 because of pain. The Claimant was admitted and an x-ray examination of his spine requested. The x-ray was thought to reveal no growth abnormality. The information provided by the Claimant whilst in the Accident and Emergency Department included a history of a previous deep vein thrombosis and pulmonary embolism.

Between 09:00 hours and 10:00 hours on 25th May 2008 the Claimant was seen by a Consultant Orthopaedic Surgeon, who noted that the Claimant had been able to pass urine normally until the previous day when he went into retention and was catheterized. However the nursing notes recorded the catheterization as having taken place at 10:00 hours that morning. The Orthopaedic Surgeon recorded normal power in both legs and feet and thought that the x-rays showed some degeneration in the lower lumbar spine. He proposed gentle mobilisation, a trial without catheter and an MRI scan on 27th May.

At about 23:45 hours on 25th May 2008 the Claimant was seen by an Orthopaedic Senior House Officer as he had experienced a further loss of sensation in his thighs and had difficulties passing urine. The Claimant was not seen by a doctor on 26th May but at 09:00 hours on 27th May the Claimant was recorded as having lost control of his bladder. An urgent MRI scan was arranged and performed later that morning. This showed an L2/L3 disc protrusion to the right and an L5/S1 protrusion to the left impinging on the S1 nerve root.

The Claimant was referred to a Spinal Surgeon who advised the Claimant that he was suffering from cauda equina.

The Claimant underwent spinal decompression surgery commencing at about 16:45 hours on 27th May but the diagnosis and surgery were too late to save him from the severe injury and consequent disability that followed.

In addition, on 24th May 2008 the Claimant’s risk of developing a deep vein thrombosis was assessed as being low but on 25th May it was assessed as being high. It was proposed that he should be provided with anti-thromboembolic stockings and that he should be given Fragmin to protect him from developing a DVT.

On 25th, 26th and 27th May the Claimant was given 2500 units of Fragmin but administration of the drug was then stopped. The spinal surgeon directed that Fragmin should be recommenced 48 hours after surgery which should have resulted in it being recommenced either late on 29th May or on 30th May at the latest. The operation was performed with the Claimant’s legs pulled up underneath his chest. This position carries with it a risk of vascular impairment below the knees due to venous kinking thereby increasing the risk of DVT and pulmonary embolism. The Claimant was immobile both before and after surgery. However, contrary to the spinal surgeon’s instructions no Fragmin was given until 18:00 hours on 3rd June and no stockings were provided.

By 13:30 hours on 3rd June the Claimant was experiencing pain on the left side of his chest and felt breathless. He was suffering from a pulmonary embolism following a DVT. However, whilst 2500 units of Fragmin were given at 18:00 hours on 3rd June, treatment doses of 5000 units did not start until about midday on 4th June 2008.

The Claimant alleged negligence on the part of the Defendant in failing to recognise when he went into urinary retention on 25th May 2008 that his condition was deteriorating such that he needed to be investigated that day for cauda equina.

A further six allegations of negligence were raised against the Defendant to include failing to perform the MRI scan and decompression surgery; failing to transfer the Claimant to the unit where MRI scanning could be undertaken and surgery performed on 26th May; failing to monitor the Claimant’s condition properly after the Orthopaedic’s visit on 25th May; depriving the Claimant of the treatment he needed to prevent the serious deterioration in his condition; failing to provide the Claimant with stockings until after he developed a DVT and failing to restart Fragmin until 3rd June by which time it was too late to prevent the DVT and pulmonary embolism.

The Claimant suffered neurological injury such that he had an L3 paraplegia requiring many months rehabilitation in a spinal injury unit. His urinary function was severely compromised. The Claimant improved but has right and left L5 radiculopathy resulting in almost complete weakness of dorsiflexion of the right foot.

He has loss of sensation in the L5 dermatome of both legs with consequent skin changes to both shins and feet and also had hip and knee weakness. He is unable to walk without sticks and uses a wheelchair for longer distances.

The Claimant was much restricted in his every day activities and has his own business but was no longer able to undertake the range of tasks previously performed by him in running it. The Claimant alleged that were he ever to need to seek alternative employment he would be seriously disabled on the labour market.

The Claimant remained troubled by frequency of micturition and required laxatives for bowel function. In addition the Claimant suffered the DVT and pulmonary embolism and in the course of a physiotherapy session on 3rd March 2011 he fell and sustained a fracture to his right tibia and fibula. The Claimant alleged that he would not have been undergoing physiotherapy and fallen in the absence of the Defendant’s negligence in May 2008.

As a consequence of his condition the Claimant suffers from a depressive disorder.

The Defendant admitted that there was a breach of duty to the Claimant in that there was a very clear delay in appreciating the significance of his presenting symptoms and in diagnosing cauda equina syndrome, but the Defendant did not accept that an MRI scan and surgery should have been performed on 25th May 2008.

Following the issue of proceedings and the service of the Particulars of Claim the parties agreed to the claim being stayed until the end of July 2012 so that the Defendant could make further investigations and the parties could explore the possibility of settlement to the claim. By 3rd August 2012 the Defendant accepted that the Claimant was entitled to Judgment for damages to be assessed. The parties agreed a further stay of proceedings to 31st January 2013 to afford the parties a further opportunity to attempt a settlement.

The parties had been unable to reach a settlement by this time. The Defendant had made one Part 36 offer to settle the claim on 25th January 2012 in the gross sum of £450,000.00.

The Parties held a joint settlement meeting which took place in October 2013. At that meeting the Defendant agreed to pay the Claimant £700,000.00 net of CRU (exceeding £25000) in full and final settlement of his claim.


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