Spinal Epidural Abscess Misdiagnosis Lawsuits

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.

The Progression of a Spinal Epidural Abscess

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:

1. back pain (over 50% of the time and usually as the first symptom) with tenderness on examination or localized spinal pain
2. radicular pain due to nerve root irritation may cause pain the abdomen or chest, or paresthesias, or both;
3. spinal cord dysfunction, characterized by defects of motor, sensory or sphincter function, and lastly
4. paralysis.

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 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."

An MRI can provide a lot of answers. An MRI can allow a proper screening for SEA without 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.

What is the average settlement value of a spinal epidural abscess claim? One malpractice insurer reported paying $754,000 in spinal epidural abscess 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.

That is Maryland. Our lawyers have collected many jury verdicts and settlements -- both plaintiffs' and defendants' verdicts -- in spinal epidural abscess cases.

A spinal epidural abscess is not a common diagnosis which is one of the reasons it is often misdiagnosed. The incidence of this disease process is between 1.2 per 10,000 patients. In recent years, doctors are seeing more spinal epidural abscess cases. Why? No one knows for sure. But there is certainly more spinal surgery than ever. It also does not help that our population is aging which increases the risk of many risk factors for an epidural abscess.

Diabetics are at great risk of a spinal epidural abscess. Approximately one-third of spinal abscess patients have diabetes Other risk factors include IV drug or alcohol use, immune compromise, alcohol abuse, steroid injections or recent spinal procedures, chronic renal failure and cancer.

Staphylococcus aureus bacteria, including MRSA, causes most spinal epidural abscesses. Staph epidermidis and gram-negative bacteria are also common causes of spinal epidural abscesses. Streptococcus pneumonia and Acinetobacter baumannii can rarely cause an epidural abscess. More than one bacterial organism is isolated in 5-10% of cases of epidural abscess. While spinal epidural abscesses may be cured with antibiotic therapy alone in some cases, laminectomy with surgical drainage of the abscess is often required.

The cause of a spinal epidural abscess is the culturing of the bacteria from the abscess. This can be either at surgery to drain the abscess or by aspirating pus from the abscess. Bacterial seeding from the abscess is common so that the causative bacteria can frequently be determined by positive blood culture.

It is not common to have more than one cause of an epidural spinal abscess. But there is some evidence that 5-10% of spinal abscesses are caused by more than one bacterial organism.

The single most important predictor of a successful neurologic outcome in spinal abscess case is the patient's neurologic status immediately before surgery. You do not see many malpractice cases where the patient was still neurologically sound before surgery.

The diagnosis can not be made reliably by a CT scan and assuming it can is a path to a medical malpractice lawsuit. But the diagnosis can be made by myelogram, a procedure in which dye is injected into the spinal canal followed by radiographic or CT imaging. This diagnosis can also be made by MRI with gadolinium injection.

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.

• Vakili M, et. al: Spinal Epidural Abscess: A Series of 101 Cases. Am. J. Med. 2017 Dec;130(12):1458-1463.
• Patel AR, et al. Spinal epidural abscesses: risk factors, medical versus surgical management, a retrospective review of 128 cases. The Spine Journal. 2014.
• Davis DP et al. The Clinical Presentation and Impact of Diagnostic Delays on Emergency Department Patients with Spinal Epidural Abscess. J Emergency Med. 2004.