Summary
At midnight on Sunday night March 17, 2013, Dana Vogel, age 43, could walk when she arrived at the Emergency Department of the Saint Louise Regional Hospital in Gilroy, California by ambulance.
On Monday morning March 18, 2013 at 12:20 am Dana was seen by an emergency medicine specialist.
The ER doctor knew from the report of the EMTs, the triage nurse and from his patient that
• she had not been in an automobile crash or suffered a severe fall
• she had been carrying a backpack earlier that week and felt pain in her neck
• she saw a chiropractor and felt fine until Sunday night when she called 911
• she walked from her living room to the EMT gurney
• she arrived by ambulance
• her legs were numb
• she had severe neck and back pain
• neck back spasm
• needed help to transfer from the EMT gurney to bed
• there had been a sudden onset of symptoms of neck and back pain
• tingling
• her “range of motion was normal,” meaning she had full leg muscle control.
These symptoms are the red flags of cord compression. The chief rule in emergency medicine is to always make sure the most critical suspected cause of physical complaints is fully evaluated or “ruled out. The only way to do that is by an immediate MRI, which is mandatory to diagnose compression of the spinal cord and the sooner the better to prevent the paralytic process to progressively worsen as time passes.
The St. Louise Hospital’s MRI scanner was only open 8 am to 4:30 pm M-F. There was no way Dana could obtain an immediate MRI at St. Louise.
Hospitals that had 24/7 MRI and neurosurgeons included Santa Clara Valley Medical Center, San Jose Regional Medical Center and Stanford University Hospital. An MRI was minutes away by open freeways that early morning at 12:20 am. Santa Clara Valley Medical Center Santa Clara Valley Medical Center is one of four adult level one trauma centers in Northern California. The other three are San Francisco General Hospital, Stanford and Sacramento’s UC Davis.
VMC operates the only federally designated spinal cord injury center in Northern California, with a trained Emergency Department and neurosurgeons who specialize in brain and spinal trauma surgery.
Progressive Spinal Cord Damage with Cord Compression
Cord compression as a result of a herniated disk is not a single event. A ruptured disk causes a build up of pressure, compounded by a loss of blood supply that creates greater and greater nerve damage the longer it progresses.
Growing pressure in the spinal column involves neurons deep in the spinal cord and continues to permanently destroy more of them until pressure is relieved. That’s why time is life when spinal cord injury is suspected.
Dana Vogel suffered a progressive worsening of her condition through the day.
At 1:20 am nurses attempted to help Dana walk. Dana collapsed. Her legs could no longer support her.
At 4:40 am the ER doctor considered that Dana’s condition was a conversion reaction, i.e. psychosomatic.
At 5:05 a neurologist, consulted by tele-medicine, found weakness in Dana’s legs and recommended an MRI of the whole spine.
At 5:30 am an MRI was ordered, although that department would not open until 9 a.m.
At 5:45 am Dana could no longer void her bladder. The most logical explanation is progressing cord compression.
At 7:45 am a new doctor saw Dana and discussed with Dana the “possibility of psychiatric cause,” which she said was “very unlikely.”
At 2:20 pm the MRI of the neck conclusively showed that a ruptured cervical 6-7 disk was invading the spinal column and causing nerve damage. At that time a call was made to begin the transfer of Dana to San Jose Regional Medical Center.
Dana finally left St. Louise at 4:55 pm in the middle of the rush hour, was evaluated at St. Louise by a neurosurgeon at 6:30 pm and immediately taken to surgery. Anesthesia began at 7:30 pm and the actual surgery began at 8:03 pm. The pressure in her cervical spine was relieved at approximately 9:00 pm. Surgery was completed at 11:10 pm.
The surgical release of pressure eventually allowed Dana to regain substantial muscle strength.
