Acute discitis

The patient, a woman in her 50s, was referred privately to the MDU member, a consultant neurosurgeon, with severe back pain. Although she had experienced back pain before, this was a new episode that began acutely after she had been gardening, which had included some heavy lifting.

The consultant undertook a full examination of the patient and noted that she had limited straight leg raising on the left side and a foot drop. In view of the history and clinical findings, he organised an MRI scan. This showed protrusion of the disc at L4/5 with impingement of the L5 nerve root. He recommended that the patient undergo microdiscectomy.

The surgery was uneventful and the patient was discharged home after three days. Three weeks later, when visiting friends, the patient was admitted to hospital with an exacerbation of her back pain. She was treated for a presumed infection and underwent another MRI scan. She was then transferred back to the care of the consultant neurosurgeon.

On reassessment, he felt the mostly likely diagnosis was one of recurrent disc prolapse rather than infection. Conservative management failed and so he decided to undertake a further operation. At the second operation the appearance was not classical of recurrent prolapse but he thought that this was still the most likely diagnosis.

Samples were taken for microbiology and the patient continued to be treated for a recurrent prolapse. Her symptoms improved and after a couple of weeks she was discharged home with follow-up in the pain clinic.

After discharge, the patient had a further MRI scan. The radiologist reported this as showing signs of acute discitis and the patient was readmitted to hospital for intravenous antibiotics. After a rather stormy course, the patient was discharged home.

The patient subsequently brought a claim against the consultant, alleging that a diagnosis of discitis should have been considered when she was readmitted to hospital, three weeks after the initial surgery. She also alleged that as a result of the delay in diagnosis and starting treatment, she was now suffering from long-term back pain and this had prevented her from returning to work. She put forward a significant claim for
loss of earnings.

Independent advice was received from a neurosurgeon. The expert was supportive of the consultant’s actions until after the second operation. His view was that following the second operation, discitis should have been considered as a diagnosis and treatment started. However, the expert added that although he believed the delay in treatment had delayed the patient’s recovery by around six months, it had had no longterm
effect on her outcome.

He did not think that her ongoing problems were as a result of the delay in treatment – they were due to the underlying diagnosis itself. In light of the expert evidence, and with the member’s agreement, the MDU settled the case. After extensive negotiations, a settlement figure of £120,000 was agreed with the claimant’s solicitors, considerably less than the original claim.

This page was correct at publication on 01/08/2012. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.