What are Common Causes of Spinal Cord Injury?
Traumatic Spinal Cord Injury
Spinal cord is injury result from a sudden, traumatic blow to the spine. Traumatic injury to the spinal cord can be caused from a motor vehicle accident, workplace injury or something as simple as a fall. In the most severe cases, traumatic spinal cord injury results in paraplegia (paralysis of the lower extremities), quadriplegia (paralysis of all four extremities), or even death.
Spinal Cord Injury from Infection, Bleeding or Mechanical Compression
The spinal cord can also be injured from causes other than trauma. In these circumstances, it can be more difficult to determine the cause of the spinal injury, or even that the patient suffers from a spinal injury at all.
Spinal Epidural Abscess
Spinal epidural abscess occurs when an infection infiltrates the epidural space around the spinal cord, causing a buildup of pus (abscess). Because it is confined to the tight space around the cord, an epidural abscess gradually compresses the cord to the point where the cord may be permanently damaged.
Spinal Epidural Hematoma
A spinal epidural hematoma is analogous to a spinal epidural abscess but involves bleeding around the spinal cord. As with spinal epidural abscess, it results in compression of the spinal cord that can cause paralysis.
Cauda Equina Syndrome
Cauda Equina Syndrome (CES) results from some type of compression of the Cauda Equina, the nerves that resemble a horse’s tail which extend out from the lower end of the spinal cord in the lower lumbar spine.
Medical Diagnosis and Treatment of Spinal Emergencies
These conditions–spinal epidural abscess, spinal epidural hematoma and CES—are medical emergencies. Although these conditions are relatively rare, data suggests that they have increased in frequency in recent years. If such conditions are not identified and treated promptly, they can result in permanent and irreversible paralysis. Because of this, medical providers are required to recognize the early signs and symptoms of these dangerous, spine conditions, and to act immediately. If providers do not recognize the condition or act to address it, and a patient develops paralysis, there may be a viable medical malpractice case.
Epidural Abscess: Diagnosis and Treatment
For epidural abscess, risk factors include the use of IV drugs or recent spine surgery. However, any surgery, injury or condition that creates an opening in the skin creates a risk of internal infection and abscess. If an infection develops within the body at one location, it can spread through the blood to the epidural space where the bacteria can seed and cause an abscess.
Early signs and symptoms of spinal epidural abscess include severe back pain near or pain radiating from the level of the abscess, as well as signs and symptoms of systemic infection, such as fever, shaking chills, loss of appetite, nausea, and fatigue. Although nonspecific, blood work showing elevated C-reactive protein, sedimentation rate or neutrophil count should increase suspicion for a spinal abscess.
MRI is the gold standard for diagnosing a spinal abscess. The MRI should focus on the level of the spine most likely, based upon the patient’s clinical presentation, to contain the abscess. For example, if the patient has symmetrical lower extremity weakness, that may suggest that the abscess is located above in either the thoracic or cervical levels, as a lumbar abscess may be more likely to affect specific nerves and therefore produce asymmetrical findings.
In cases where the location of the suspected abscess is unclear, full spine imaging must be done to identify the abscess as quickly as possible. For patients who cannot undergo an MRI, CT with contrast dye or CT myelogram may be reasonable alternatives.
If imaging shows a compressive spinal epidural abscess, the standard of care requires urgent surgical decompression (opening the epidural space and draining the abscess to relieve compression on the cord). If the abscess is decompressed before the patient progresses to paralysis, the patient will likely avoid paralysis. Additionally, timely surgery will afford many patients the opportunity for substantial neurological recovery.
Spinal Epidural Hematoma: Diagnosis and Treatment
Patients at highest risk for spinal epidural hematoma include those who have had a recent spine surgery (for example, implantation of a spinal cord stimulator, epidural catheter for pain control, etc.) and those taking anticoagulation medications. When a person develops a spinal hematoma absent surgery or trauma, it is referred to as a “spontaneous” epidural hematoma.
Unlike an epidural abscess, hematoma does not cause signs and symptoms of infection. Otherwise, the early symptoms are similar to an abscess, including pain at or radiating from the site of the hematoma, followed by progressive loss of neurological function resulting in sensory deficits and weakness. MRI, followed by contrast CT or CT myelogram, are the imaging studies of choice to confirm or rule out spinal epidural hematoma. Just as with an abscess, the treatment for an epidural hematoma is prompt surgical decompression.
Cauda Equina Syndrome: Diagnosis and Treatment
CES involves compression of the nerve roots of the Cauda Equina in the lumbar spine. This can result from an acute trauma or a chronic process such as a herniated disc or compressive degenerative change like a calcified osteophyte that presses on the nerve roots. CES can also be caused by an abscess. Signs of CES include severe lower back pain, leg weakness, saddle anesthesia and bladder or bowel dysfunction. As with abscess and hematoma, the diagnosis of CES is made with advanced imaging and CES is treated with surgery to reduce the compression on the nerve roots.
Medical Malpractice Resulting in Spinal Cord Injury
In the past few years, we have litigated through successful conclusion at least a half dozen medical malpractice cases involving delay in diagnosing and treating epidural abscess, hematoma, or CES. The allegations of negligence in these cases have included the following:
- Delay in ordering imaging to confirm or rule out spine process despite signs and symptoms concerning for abscess, hematoma or CES.
- Delay in completing imaging after determining that imaging was necessary to confirm or rule out abscess, hematoma or CES.
- Delay in reviewing, communicating, or acting upon findings in imaging that showed abscess, hematoma or CES.
- Delay in administering antibiotics in patients with spinal epidural abscess.
In each case, we were able to show that, during the delay, the patient progressed from having a treatable spine lesion to a cord injury that was permanent and irreversible.
Our clients in these cases suffered complete or near-complete paralysis with lack of muscle and sensory function in their lower (or upper and lower) extremities along with lack of bowel and bladder function. Such injuries are devastating for the patient and their families. Through our work in these cases, we have helped clients recover money to pay for medical devices, home and vehicle adaptations, in-home personal care, income replacement, and for the countless other ways in which para- or quadriplegia can change a person’s life.