Deviation in the Standard of Care in the Treatment of Herniated Discs (Herniated Disc)

Evaluate breaches in the standard of care by asking and answering the questions below to evaluate whether or not there has been a Deviation in the Standard of Care in the Treatment of Herniated Discs (Herniated Disc)

Answer the following questions to find out if the standard of care was followed for your case.

  • With which of the following symptoms did the patient present? (Choose all that apply)
    Back pain
    Numbness
    Tingling
    Loss of function or strength in legs
    Radiating symptoms in the legs
    Weakness
    Sensory loss
    Back pain worsening with coughing and sneezing
    Symptoms not elicited
    Answer unknown
    Why is this important?
    Disc herniation, is a displacement of the lumbar disc from its anatomic location between the vertebrae (often into the spinal canal).
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  • Was a detailed medical history obtained from the patient? Why is this important?
    Answer this question
    
Past medical history (PMH) includes all past and current illness, hospitalizations, surgery, trauma, allergies, and medications. The date, location, and physician/surgeon for each hospitalization and/or surgery must also be included. Particularly important issues in the identification of manifestations of systemic disease include alcoholism, cancer, cardiovascular events, diabetes, and hepatic, renal, and psychiatric reasons for admission. Particularly important medications for oral manifestations include immuno-suppressives, antibiotics, cardiac medications, and psychotropics. The PMH is also important for investigating whether the chief complaint (CC) is a manifestation of a previously diagnosed disorder.

    (2011) 55 EDECNA 1 15-28 



  • Was a thorough musculoskeletal and neurological examination performed? Why is this important?
    Answer this question
    
The most important elements in the evaluation of lumbar radiculopathy are the history and physical examination.

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  • Was non-surgical management advised? Why is this important?
    Answer this question
    
The conservative treatment of herniated nucleus pulposus focuses on controlling symptoms of pain, strengthening the patient's muscles and restoring muscle function.

    (2005) 13 EOTSMD 2 114-121 



  • Which treatment did the patient undergo? Why is this important?
    Answer this question
    
An initial period of conservative treatment for at least four to eight weeks is indicated, unless the patient presents with progressive neurologic deficits, recurrent episodes of incapacitating pain, and/or profound motor weakness.

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  • Did patient’s symptoms resolve with medical management? Why is this important?
    Answer this question
    
Numerous medications have been used with various results in subacute and chronic back and leg pain syndromes. Oral steroids used briefly can be beneficial as potent anti-inflammatory agents. The many types of non-steroidal anti-inflammatory drugs (NSAIDs) also are helpful when aspirin is not tolerated or is of little help. Numerous NSAIDs are available for the treatment of low back pain.

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  • Did patient’s symptoms resolve with conservative treatment? Why is this important?
    Answer this question
    
If the patient’s symptoms persist after efforts at conservative treatment have been exhausted, a more aggressive approach may be warranted.

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  • Was Physical therapy prescribed? Why is this important?
    Answer this question
    
Physical therapy must be used judiciously. The exercises must be suited to the symptoms and not forced.

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  • Did the physical therapy alleviate the patient’s symptoms? Why is this important?
    Answer this question
    
Improvement in symptoms following physical therapy indicates a more favorable prognosis. 

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  • Were epidural steroid injections recommended? Why is this important?
    Answer this question
    
Epidural steroid injections (ESIs) are a common form of treatment for acute and chronic spinal and radicular pain.

    (2009) 13 ETRAPM 4 236-250 



  • Did the patient develop complications after the epidural steroid injection? Why is this important?
    Answer this question
    
Epidural steroid injections (ESIs) are a form of interventional therapy broadly used worldwide for the treatment of pain, and are considered a safe treatment, with a low incidence of complications.

    (2009) 13 ETRAPM 4 236-250 



  • Did the epidural steroid injections alleviate the patient's symptoms? Why is this important?
    Answer this question
    
Epidural steroid injections (ESIs) are a common form of treatment for acute and chronic spinal and radicular pain.

    (2009) 13 ETRAPM 4 236-250 



  • Which of the following imaging studies were performed? Why is this important?
    Answer this question
    
Imaging techniques such as magnetic resonance imaging (MRI) have contributed to a better understanding of the physical characteristics and accuracy of disc herniations. MRI has largely replaced computerized tomography and myelography in the preoperative diagnostic evaluation of low back pain and radiculopathy because it has superior resolution and is better able to detect subtle herniations as well as far lateral herniations.

    (2005) 5 ESPNJL 6 608-614 



  • Did the imaging study reveal any instability of the spine? Why is this important?
    Answer this question
    
In lumbar fractures, certain patterns of injury can be defined as unstable, even in the absence of neurologic deficit. Patients with severe disruption of the posterior ligamentous complex from a flexion or flexion-distraction injury are considered to have unstable injuries.

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  • Was the patient advised to undergo spinal fusion? Why is this important?
    Answer this question
    
With continued instability of the lumbar spine, supplemental posterior or posterolateral fusion may be warranted.

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  • With which of the following symptoms did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    
The symptoms of cauda equina syndrome are acute urinary retention, saddle anesthesia, anal sphincter tone decrease, acute fecal or urinary incontinence, bilateral lower-extremity weakness or numbness and progressive neurologic deficit.

    (2008) 89 APMERE 9 1830-1845.e4 



  • Was a pre-operative assessment performed? Why is this important?
    Answer this question
    
The purposes of preoperative testing are to assess a pre-existing health problem, further characterize a suspected problem, influence peri-operative management, and predict peri-operative complications in patients in whom some risk factor is suspected, testing is appropriate and may include a complete blood count, coagulation studies, serum chemistry (including liver function tests), echocardiography, electrocardiography, cardiac stress testing, chest radiography, pulmonary function tests, and pulse oximetry. Pregnancy testing must be performed in women of childbearing capacity.

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  • Was an informed consent obtained from the patient prior to the surgery? Why is this important?
    Answer this question
    
The laws of most states require that surgeons obtain informed consent before providing treatment.

    (2011) 23 EOMSCA 3 475-484 



  • Were prophylactic antibiotics administered to the patient? Why is this important?
    Answer this question
    
Antibiotic prophylaxis significantly reduces the incidence of postoperative superficial and deep incisional surgical site infections.

    (2004) 61 ESURNU 2 129-135