Congenital spine deformity, congenital stenosis, diastematomyelia, and tight filum terminale in a workmen's compensation patient: a case report

Abstract

Study design: This case report concerns a patient injured at work who was denied adequate evaluation and treatment by a Workman's Compensation Commission, resulting in nearly complete paraplegia.

Objectives: For a patient with a congenital spine deformity, a diastematomyelia, a tight filum terminale, and a congenital stenosis, denial of magnetic resonance imaging evaluation and appropriate surgery cannot be justified.

Summary of background data: This 35-year-old man injured his knee and back in a fall at work but was able to work for 1 week. Progressive neurologic deterioration was documented, but magnetic resonance imaging evaluation was denied. When it finally obtained and the lesion identified, appropriate neurosurgery was denied.

Methods: When seen by the authors more than 3 years after his injury, he had a nearly complete paraplegia. Despite neurosurgical decompression and spine stabilization, no significant recovery occurred.

Results: A nearly complete paraplegia resulted from this combination of lesions coupled with intolerable delay in diagnosis and therapy, both the result of "foot-dragging" by a Workmen's Compensation Commission.

Conclusions: In an effort to be "cost-conscious" and to avoid "unnecessary low back surgery," a Workmen's Compensation Commission has caused a patient to become paraplegic. Such management is neither cost-effective nor of adequate quality.