A spinal epidural abscess ("SEA") is a disorder caused by an infection inside the spine. This infection is caused by bacteria or fungal organisms, usually after a surgical procedure.
Failure to diagnose a spinal abscess may result in a medical malpractice case. Why? Because more often than not, the infection could have been controlled, if the doctor or nurse did not violate the standard of care. There is literature to prove that doctors have cautioned other doctors by saying, essentially, if you delay diagnosing a spinal epidural abscess, you are going to get sued.
An epidural abscess is a localized collection of pus between the dura mater and the skull or vertebral column. A spinal epidural abscess is a pocket or collection of pus that develops in or near the epidural space in the spinal column. The epidural space is located in a critical spot on the human body between the vertebrae and spinal cord.
What causes a spinal epidural abscess? The cause can be from a remote source such as distant infection or something closer to the epidural space. There are many spinal epidural abscesses without an identifiable source.
Spinal epidural abscesses are almost always manageable when caught in an early stage. However, paraplegia, quadriplegia or death can result, if the diagnosis is not promptly made and treatment is not initiated.
Like many things, the key is to catch it early. If the symptoms are there and a doctor or nurse fails to diagnose, you more than likely have a viable malpractice case.
The sequential evolution for SEA misdiagnosis tragedy often goes like this:
- back pain (over 50% of the time and usually as the first symptom) with tenderness on examination or localized spinal pain
- radicular pain due to nerve root irritation may cause pain the abdomen or chest, or paresthesias, or both;
- spinal cord dysfunction, characterized by defects of motor, sensory or sphincter function, and lastly
SEA often presents with a complaint of neck pain radiating to the abdomen, or flank pain. SEA is frequently accompanied by a fever (about 33%). The big complaint is pain, usually accompanied by local tenderness at the affected area. Typically, specific neurological signs depend on the level of the spinal cord involvement.
Doctors, including emergency room physicians, have been trained to rule out a spinal epidural abscess when the patient presents with symptoms that would cause a reasonable doctor to be on alert.
Early diagnosis is crucial. The length of time and degree or severity of the spinal cord compression have a direct impact upon the permanency of the deficits. This is because the longer the nerve fibers are compressed, the greater the degeneration.
Clinical Markers to Verify SEA Diagnosis
If a doctor has any SEA suspicions, there are easy clinical markers that can help verify, if the patient is at grave risk of SEA. These markers consist of (1) a community acquired staphylococcus aureus bacteremia (SAB); (2) skin lesions suggesting acute systemic infection; (3) the presence of fever at 72hrs; (4) a positive blood culture at 48 hrs.
If there is a positive finding for SAB, doctors are required to follow an algorithm consistent with the article “Clinical Identifiers of Complicated Staphylococcus Aureus Bacteremia."Getting an MRI
An MRI can provide a lot of answers. An MRI can allow a proper screening for SEA without a great risk, unlike lumbar punctures and myelograms. An MRI can show epidural infections promptly and at an early stage of the disease when any neurological deficit is more likely to be reversible.
Conversely, a delaying decompression and antibiotic treatment for SEA results in poor outcomes and permanent neurological damage. Therefore, SEA medical malpractice cases are frequent because the key prognostic factor for a favorable outcome for the patient is early diagnosis and treatment.Value of These Cases
What is the average settlement value of a spinal epidural abscess claim? One malpractice insurer reported paying $754,000 in SEA claims. You should not rely on this information because every case really is different. Still, people still want some statistical idea of what to expect with SEA claims - this gives you some indication of how these claims are being valued when the insurance company -- or a jury -- believes the doctor made a mistake.
Here is one sample Maryland verdict:
- 2015, Maryland. $1,240,000 Verdict. A 72-year old male is under the care of defendant urologist. He develops a fever, back pain, and staph infection and is admitted to the hospital. He is hospitalized for eleven days before being diagnosed with an epidural abscess. He argues that if defendants had properly and timely diagnosed his condition, he would not have suffered permanent paralysis. The defense argues that the result would have been the same, regardless of the timing of the diagnosis. A jury awards the plaintiff $1,250,000.
- Get more jury verdicts and settlements -- both plaintiffs' and defendants' verdicts -- in spinal epidural abscess cases
If you or a loved one has suffered a spinal epidural abscess as the result of a delay in diagnosis or treatment, call our experienced medical malpractice legal team at Miller & Zois. We can help you get the compensation you deserve for the mistakes that were made.
Call 800-553-8082 today or get a free, no obligation on-line case evaluation. There is no cost to you for this review, and you only pay us if we get a financial recovery for you.