CASE VIGNETTE – SEPTEMBER 2020

The Erosive Effects of Time

I recently reported on an individual who had sustained a significant lumbar spinal injury over a decade ago.

Eight years ago, he was subjected to an operative discectomy that was apparently quite successful. Three years thereafter, he presented with an epidural abscess. Complications of this nature are exceedingly rare. If sepsis is to occur following an operative procedure on the lumbar spine, it is usually apparent within days, weeks or possibly even months. A hiatus of three years is very unusual. What is more unusual would be for an unprovoked or de novo septic event to occur. That is to say, although the link between his index surgery and the subsequent appearance of the abscess is very weak, it is infinitely stronger than the abscess occurring without any relationship at all to the discectomy. At first sight, it appeared that his claim was quite straightforward and reasonable.

The difficulty arose in the original cause of his lumbar spinal problem and the need for the discectomy two years later. Documentary evidence was lacking. There were general practitioner notations confirming that injuries had occurred, but none had specifically located an injury to the lumbar spine itself.

From an orthopaedic perspective, it is not usually possible to differentiate between a single specific incident or an injury occurring over a protracted period as a result of the repetitive application of excessive stresses and strains.

Ultimately, it becomes an issue for the Court.