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

Abstract

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. 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. 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. 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. 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. 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.