This case involves a female patient in her early thirties who presented to a pain management specialist in Idaho complaining of a numbing sensation in her left leg that had gotten progressively worse over the course of several years. Treatment with epidural injections and other medications failed to provide benefit, as did subsequent physical therapy. Eventually, the patient elected to undergo surgical removal of several herniated disks, and developed discitis and osteomyelitis following the procedure. The patient’s infection required the placement of a PICC line for antibiotics, and she continues to experience numbness and tingling in her left leg along with numerous other complications.
Question(s) For Expert Witness
- 1. Do you routinely perform percutaneous discectomy procedures?
- 2. Have you ever had a patient develop the outcome described above?
Expert Witness Response E-000104
I perform portions of the percutaneous discectomy procedure simultaneously with a primary surgeon, who is a spine surgeon. I use this arrangement on my patients so that in the event of intra or postoperative complications the surgeon can handle the complications that fall outside of my expertise. I have never had a patient develop the outcome in this case. The most important questions are was it preventable (was there an obvious breach in sterility and technique) and was it detected and treated early enough and properly enough to mitigate the damage? The diagnosis was still in question and that the discectomy was premature, but stating that intradiscal antibiotics are standard of care is not correct. Also, epidural granulation tissue in the vicinity of the nerve roots strongly enhances postoperatively. What is important are the findings in the disc space and the bone surrounding the disc space. Lastly, the diagnosis of postoperative discitis is made using clinical findings, imaging and laboratory findings. There is no mention of the laboratory findings in the report which would be important.