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When surgical treatment of a spinal epidural haematoma is negligently delayed, what neurological and functional recovery a person would likely have had absent the negligence, is often a key battle ground between the parties.
What is a spinal epidural haematoma ?
Spinal epidural hematoma (SEH) is an accumulation of blood in the epidural space between the vertebrae and the dura of the spinal canal.
Causes of SEH include trauma, surgery, epidural catheterisation or disorders of coagulation. In many cases no cause is found and the SEH is diagnosed as ‘spontaneous’.
Patients with underlying conditions which leave them vulnerable to spinal fracture, like ankylosing spondylitis, are known to be particularly at risk of spinal epidural haematoma.
SEH is diagnosed using an MRI scan, or if that is not immediately available, CT myelography.
Effect
SEH is often asymptomatic, but in rare cases it will mechanically compress the spinal cord, with potentially devastating neurological consequences. These symptoms include sensory disruption, bowel and bladder incontinence, motor weakness, or, in severe cases, complete paralysis of the affected limbs.
A spinal epidural haematoma causing cord compression and neurological deficit is an emergency situation requiring immediate surgical drainage.
Recovery
What many people may find surprising is that a good outcome can be achieved with expeditious surgery, even in patients with severe neurological deficit like paralysis.
Factors influencing recovery
Studies suggest that the two predominant factors in determining neurological outcome in patients with SEH are duration and severity of neurological deficit. Factors like sex, age, size and position of the haematoma and rate of decline, do not appear to have a significant impact on post-operative outcome.
Different studies on the treatment of spinal haematomas have identified different deadlines for surgical treatment. However, the 12 hour mark appears particularly significant in terms of recovery.
A large study in 2003 on the management of those with SEH found the majority of patients with a spinal haematoma who underwent surgery within 12 hours and survived, had either complete recovery or recovery with only mild neurological deficits.
In relation to severity, whether the spinal cord injury is complete or incomplete is an important predictor of outcome. A complete spinal cord injury occurs when a person loses all sensory and motor function below the level of the spinal cord injury. When a person with a spinal cord injury retains some function below the level of the injury, they have an incomplete spinal cord injury.
Patients with complete spinal cord injury (motor, sensory bladder and bowels) unsurprisingly have a worse prognosis, than those with an incomplete injury. However even a complete spinal cord injury does not mean that a patient will remain paralysed permanently, if the haematoma can be evacuated in a timely manner and the cord decompressed.
Why is timing important ?
If the window of opportunity to provide corrective treatment for SEH, is missed it might amount to clinical negligence and a patient may consider making a claim.
To be successful in a claim for clinical negligence you must prove not only that surgery was negligently delayed, but that in the absence of the negligent delay there would have had a better outcome.
Patients (particularly those with an incomplete spinal cord injury) whose spinal decompression surgery has been negligently delayed beyond 12 hours, may be in a strong position in this regard.
Kingsley Napley are specialist spinal injury solicitors and understand the devastating impact a spinal injury can have on a person’s daily life. We have extensive experience in obtaining substantial compensation for clients who suffer a spinal injury as a result of clinical negligence.
If you would like to speak to a solicitor about whether you may have a claim in relation to negligently delayed treatment of a spinal epidural haematoma, please do not hesitate to contact us on enquiries@kingsleynapley.co.uk or call us on 0207 814 1200.
fURTHER INFORMATION
If you would like any further information or advice about the topic discussed in this blog, please contact our Medical Negligence and Personal Injury team.
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