This case involves a 28-year-old female rock climber who developed cauda equina syndrome after undergoing a microdiscectomy. The patient suffered a large paracentral herniated disk while on an outdoor climb and had intractable pain down her leg at the time of surgery. She had no loss of bowels or saddle anesthesia prior to the surgery. The neurosurgeon performed the operation initially utilizing the METRx surgery system. The neurosurgeon then switched to an open procedure after discovering spinal fluid leaking from a tear made during the placement of the METRX surgical dilators and tube. The patient awoke in severe pain in her legs, numbness to her perineal area, and was left incontinent. Additionally, the neurosurgeon never told the patient that she had developed cauda equina syndrome. She later went for a second opinion and obtained the correct diagnosis there. An expert in neurosurgery was sought to review the medical records and opine on the standard of care.
Question(s) For Expert Witness
- 1. How often do you use the METRx system when performing microdiscectomies?
- 2. What are some common complications of the procedure described? Is Cauda equina syndrome one of them?
Expert Witness Response E-041882
I am the chief of neurosurgery at a major medical center, the associate director of the neurosurgery residency program, and an associate professor of neurosurgery. I teach neurosurgery residents and regularly lecture to surgeons about aspects of spine surgery. I have taught a spinal complications course, including about CSF leaks. I am very familiar with the METRx system. Some common complications include radiculitis, recurrent disk herniation, infection, epidural hematoma, CSF leak. Cauda equina syndrome is rare. If the symptoms were due to compression from excessive dural repair glue applied or from a postoperative hematoma that was not diagnosed, then this is a clear case.