Spinal Epidural Abscess Misdiagnosis Lawsuits

This page is about spinal epidural abscess lawsuits.  Our lawyer discuss the type of claims that are viable and drill down on settlement amount and jury payouts victims see.

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 a distant infection or something closer to the epidural space. There are also 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.

Failure to Diagnose Spinal Epidural Abscess

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 72 hours; (4) a positive blood culture at 48 hours.

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 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 Settlement Value of Spinal Epidural Abscess Claim?

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.

Below are summaries of verdicts and reported settlements in cases involving failure to diagnose or treat spinal epidural abscess:

• $2,500,000 Settlement (South Carolina, 2023): A 68-year-old man visited the emergency room, where imaging tests of his cervical and thoracic spine were ordered. However, inexplicably, these tests were delayed without a valid explanation, despite the man’s worsening neurological condition. His symptoms escalated to the point where he lost all sensation and the ability to move his lower extremities before any MRIs were conducted. The eventual diagnosis came from the man’s personal cardiologist during a hospital visit, not the initial medical team. By the time the emergency MRIs were performed, confirming the spinal abscesses, significant damage had occurred. Treatment involved spinal decompression and intensive rehabilitation, yet the patient remained mostly confined to a power wheelchair, with only minimal ability to walk.
• $3,500,000 Settlement (Massachusetts, 2023): A man suffering from full body pain, lethargy, dry mouth, and changes in speech visited an emergency department. His initial tests indicated sepsis and an ongoing infection, leading to hospital admission and antibiotic treatment. Despite this, his back and neck pain persisted. Two days after admission, the care team, including an internal medicine doctor and an infectious disease specialist, suspected a spinal infection and ordered an MRI. The MRI interpreted by the defendant radiologist showed multiple bilateral, walled-off fluid collections along the spine, indicative of abscesses. However, the radiologist’s report underestimated the extent of the abscess, which actually spanned from the plaintiff’s neck to his lower back. This critical oversight delayed proper surgical intervention.  The plaintiff’s condition dramatically worsened, resulting in paralysis from the neck down after emergency surgery failed to reverse the damage caused by the longstanding abscess. This severe outcome led to a spinal epidural lawsuit against the radiologist, who settled for $3.5 million.
• $23,199,615 Verdict (New York 2023): The plaintiff, 65-year-old male, began to experience intermittent neck pain and was prescribed prednisone by his primary care physician. The plaintiff said his pain increased, an MRI indicated fluid in the epidural space at C5-C6 and inflammatory changes, and he was advised to go to a hospital with the MRI results for blood work to rule out an infection. The plaintiff said laboratory tests were performed, the test results were high, and the defendant and others discharged him based on the belief that the elevated test results were secondary to the prednisone. When he came back days later, he was finally diagnosed with a spinal epidural abscess leaving him paralyzed.
• $7,600,000 Verdict (Florida 2022): The plaintiff went to the defendant hospital and was not timely diagnosed and treated for what eventually turned out to be a spinal epidural abscess. His epidual malpractice lawsuit claimed that the defendant physicians were negligent in not emergently transferring him to a hospital where he could have received timely surgical treatment for a spinal epidural abscess, instead observing his declining neurological status, resulting in his becoming quadriplegic.
• $14,000,000 Verdict (Illinois, 2021): The plaintiff experienced severe neck pain but was not timely diagnosed, leading to a spinal cord injury. He sued the hospital. The defense primarily blamed the radiologist, arguing she was solely responsible as she misinterpreted a CT scan and discharged the man.  Nonetheless, the jury was instructed that they found the radiologist was acting as an apparent agent of the health center to disregard the center’s sole proximate cause defense.
• $4,700,000 Verdict (Pennsylvania 2020): The decedent went to the defendant doctor with severe back pain. She ordered an x-ray and prescribed medication and sent him home. 2 days later he was in such severe pain that he went to the hospital where an MRI eventually diagnosed him with a spinal epidural abscess. He died several days later.  The family’s spinal epidual abscess lawyer filed a wrongful death lawsuit alleged that the defendants were negligent in failing to timely diagnose and treat the spinal abscess.
• $3,070,000 Verdict (Texas 2019): The plaintiff, a 69-year-old man, claimed he suffered permanent damage to his spinal cord resulting in flaccid paralysis to his lower extremities when the defendants allegedly failed to timely diagnose and treat an epidural abscess. The plaintiff contended the defendants were negligent in failing to properly or timely assess and report his deteriorating condition, failing to emergently order appropriate diagnostic testing and imaging studies, and failure to timely diagnose the epidural abscess; the plaintiff contended that timely diagnosis and surgical treatment of the epidural abscess would have allowed him to regain full function of his lower extremities.
• $1,240,000 Verdict (Maryland 2015): 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.

Our lawyers have collected many other jury verdicts and settlements — both plaintiffs’ and defendants’ verdicts — in spinal epidural abscess cases from around the country.

Is a Spinal Epidural Abscess a Common Diagnosis?

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.

Who Is at Greatest Risk of an Epidual 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.

What Causes an Abscess in the Spine?

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.

How is the Abscess Created?

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.

Can More Than One Bacteria Cause an Epidural Abscess?

While it is not common for more than one bacterium to cause an epidural spinal abscess, there is evidence indicating that 5-10% of these abscesses involve multiple bacterial organisms. This phenomenon, although relatively rare, complicates the diagnosis and treatment of spinal epidural abscesses.

A study published in the Journal of Neurosurgery: Spine found that mixed bacterial infections were present in a small percentage of spinal epidural abscess cases, underscoring the need for thorough microbiological evaluation in suspected cases.

So while single-organism infections are the norm, doctors must remain vigilant for the possibility of multi-bacterial involvement, particularly in complex or atypical cases.

What is the Best Predictor of Success in a Spinal Abscess Case?

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.

Will a CT Scan Catch a Spinal Epidural Abscess?

Relying solely on a CT scan to diagnose a spinal epidural abscess is not only unreliable but can also lead to a medical malpractice lawsuit.

CT scans are often insufficient for detecting the detailed aspects of spinal epidural abscesses and doctors have to know this. What should doctors do?  A myelogram, which involves injecting dye into the spinal canal followed by radiographic or CT imaging, is a more accurate diagnostic tool.

Additionally, an MRI with gadolinium injection is considered the gold standard for diagnosing spinal epidural abscesses due to its superior ability to reveal the extent and nature of the infection. Misdiagnosis or delayed diagnosis due to improper imaging choices too often results in severe patient harm and launches many spinal epidual abscess malpractice lawsuits.

Getting a Lawyer

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 online case evaluation. There is no cost to you for this review, and you only pay us if we get a financial recovery for you.

Supporting Spinal Abscess Literature

1. Chen, M., et. al (2024). Long-term survivability of surgical and nonsurgical management of spinal epidural abscess. The Spine Journal, 24(5), 748-758.  The study compared long-term survival rates of patients with spinal epidural abscess treated either surgically or without surgery. Out of 250 patients studied, about 14% died, with most deaths occurring within the first 90 days after treatment. Patients who underwent surgery had a lower death rate (13.07%) compared to those managed medically (16.22%). Surgical treatment notably reduced the risk of death by over 60%. However, those who had surgery stayed in the hospital longer on average. The research found that factors like poor nutrition, severe health ratings, and conditions like sepsis significantly raised the risk of death. Overall, surgery appears to be more effective in reducing the risk of death from this condition than non-surgical treatments.  The significant difference in mortality rates between surgical and nonsurgical treatments highlights the importance of informed consent. Patients must be fully informed about the potential outcomes of different treatment options, including the statistically lower risk of death associated with surgery, as shown in the study. Failure to provide this information could be viewed as a lack of informed consent, potentially leading to liability in a malpractice case.  Arguably, this finding also suggests that surgical intervention may significantly reduce mortality compared to nonsurgical management. This could affect what is considered the standard of care in a medical malpractice lawsuit for treating spinal epidural abscess. In lawsuits, if a patient suffered adverse outcomes or died, a spinal epidural abscess lawyer for the victim could argue that failing to perform surgery deviated from the standard of care if the patient’s condition was suitable for surgical intervention.
2. Pi, Y., et al (2023). Extensive spinal epidural abscess caused by Staphylococcus epidermidis: A case report and literature review. Frontiers in Surgery, 10. https://doi.org/10.3389/fsurg.2023.111472. The article underscores that prompt diagnosis of extensive SEA is vital. Patients with back pain and potential signs of SEA should be quickly assessed, with immediate tests like ESR, CRP, blood culture, and MRI. If SEA is detected, and other treatments fail, surgical interventions become necessary, especially with significant neurological symptoms. While some patients may avoid surgery with effective antibiotic treatment, ongoing monitoring is crucial due to potential risks. Treatment duration should be based on clinical signs, lab results, and imaging, with immediate broad-spectrum IV antibiotics being essential. Acute symptom patients should consider surgical options for extensive SEA as supplementary treatment.
3. Vakili M, et. al: Spinal Epidural Abscess: A Series of 101 Cases. Am. J. Med. 2017 Dec;130(12):1458-1463.  This studyexamines the incidence, risk factors, and outcomes of spinal epidural abscesses (SEAs) over a ten-year period at a large academic hospital. SEAs are rare but potentially devastating infections that often elude early diagnosis. The retrospective study, conducted from 2004 to 2014, identified cases using ICD-9 code 324.1 and reviewed medical and radiographic records to confirm each case. The findings revealed an incidence rate of 5.1 cases per 10,000 admissions, with no significant changes during the study period. The route of infection was identified in 52% of cases, with bacteremia being the most common (26%), followed by recent surgery or procedure (21%) and spinal injection (6%). An identifiable underlying risk factor was present in 84% of cases, most commonly diabetes and intravenous drug use. The causative organism was identified in 84% of cases, predominantly Staphylococcus aureus, with methicillin-resistant isolates accounting for 25% of S. aureus cases. Treatment involved intravenous antibiotic therapy for all cases, with 73% also undergoing a drainage procedure. Despite these interventions, 15% of cases had an adverse outcome, including 8% resulting in paralysis and 7% in death. The study suggests a potentially increasing incidence of spinal epidual absesses compared to historical data, highlighting the importance of early diagnosis and treatment to mitigate substantial morbidity and mortality associated with this condition. Plaintiff’s spinal abscess medical malpractice lawyers can use this study to demonstrate that spinal epidural abscesses, while rare, have identifiable risk factors and routes of infection that should be recognized by competent medical professionals. The attorney, using expert testimony as support, argues argues that failure to diagnose or timely treat an SEA, especially in the presence of common risk factors such as diabetes, intravenous drug use, or recent surgery, constitutes negligence. By referencing the study’s findings on the incidence, risk factors, and outcomes, the lawyer can build a compelling case that the healthcare providers failed to meet the standard of care required, leading to the patient’s harm.

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