Always consider serious spinal pathology whenever a patient presents with severe back pain. The following is a real malpractice case with some dates/info changed to fit the format. The case settled for $2.75 million. That part has not been changed.
Case:
On Monday, a patient presented to the ER with severe upper and mid back pain rated as a 9/10. There was no associated trauma. His medical history was only significant for recently having had an abscess incised on his buttocks. He was afebrile and labs showed a normal white blood cell count. Chest x-ray was unremarkable. He was given pain medication and discharged home.
The same day, he returned due to worsening back pain. He was still afebrile and was again discharged home with a diagnosis of ‘muscle strain’ and pain medication.
On Thursday, he returned to the same ER with back pain rated as an 8/10. He was unable to sit still to have his vital signs checked and was visibly uncomfortable. A physician assistant evaluated him on this visit and ordered additional pain medication. No new labs or imaging studies were done. He was again diagnosed with ‘muscle strain’ and discharged home.
On Friday, he went to the same ER. This time, he reported the back pain along with two days of leg numbness and abdominal pain. He rated his pain as 10/10 and noted painful urination. Bladder scan revealed over 700cc of urine. This time, an MRI was ordered and showed an epidural lesion involving T5-T7 with evidence of cord compression.
The patient underwent an emergent laminectomy/decompression and evacuation of an epidural abscess. Today, he remains paralyzed from the waist down and with a chronic indwelling foley catheter. The case settled for $2.75 million.
Teaching points:
- When a patient bounces back with the same complaint, don’t repeat the same plan. If it didn’t work the first time, it won’t work the second.
- Perform a thorough history and physical examination in patients with severe back pain. Check strength, reflexes, saddle anesthesia, and bladder continence among others.
