Failure To Diagnose Unstable Cervical Fracture
Significant six-figure recovery for a Blair County man who suffered spinal cord damage when his doctors failed to discover an unstable cervical fracture and unwisely permitted him to be up and out of bed walking around. The walking caused the fracture to shift and cause bruising of the spinal cord.
Unstable vertebral fractures are a very serious problem for trauma patients. The vertebrae are circular-shaped, bony structure, which are stacked one on top of the other from the neck down to the tailbone and which surround the spinal cord. When you have a fracture of one of these vertebral bodies, which is "unstable" that means the bone fragments could shift or move at any time and hit the spinal cord. To prevent that from happening, it is very important that patients with unstable vertebral fractures be kept on strict bed rest and often with traction.
The first step in treating spinal fractures is, of course, to correctly diagnose them. In other words, you have to have an imaging study, typically a CT scan, which is correctly interpreted by the radiologist. They have to look at the fracture lines and the general configuration of the bones to figure out if the fracture is stable or unstable. Once it is determined to be unstable, then it is the trauma doctor's responsibility to make sure that the patient is not up walking around.
In this case, there was a miscommunication between the trauma doctor and the surgeon as to whether it was ok for the patient to be up and out of bed. Their instructions to the hospital staff were confusing and, as a result, a therapist came into the patient's room thinking it was ok to get the patient out of bed and exercise him and, as soon as they did so, the fragments of the fracture apparently shifted because the patient said he immediately felt something like an electric shock down his spine. The doctor ordered another CT scan and indeed it showed that the fracture had shifted and was now pressing on the cord. The patient required emergency surgery, but he was still left with permanent weakness in the legs and balance problems. This case points up the importance of communication between all people on the treatment team.
One of the things that made this case challenging from the damage standpoint was that this man had a mild case of Parkinson's disease before he suffered the vertebral fracture. Therefore, we had to separate out which part of his difficulty in walking and balance was due to the spinal cord injury as opposed to the Parkinson's. In order to do that, we relied on his prior records as well as the abrupt change in his condition, which happened after he was improperly raised up out of bed with the unstable fracture.