Delayed Cauda Equina Diagnosis After Spinal Neuroplasty: 340 Million Won Settlement

Case Overview

A patient in her late twenties sought treatment for persistent lower back pain and left leg numbness. After a non-surgical spinal procedure, she developed symptoms consistent with cauda equina syndrome — a serious condition involving compression of the nerves at the base of the spine — but the hospital observed her for more than a week without ordering further imaging or surgery. Taeshin Law Firm represented the patient and her mother through trial and appeal, ultimately securing a settlement of 340 million won after the hospital withdrew its final appeal.

Background

The client had experienced lower back pain and numbness in her left leg for about a month. An MRI revealed a herniated disc in the lower spine. When physical therapy and medication failed to provide relief, an orthopedic specialist recommended epidural neuroplasty, a minimally invasive procedure in which a thin catheter is guided toward the tailbone to inject medication around the affected nerve and break up adhesions.

On the evening of the procedure, the client reported a dull or reduced sensation in her buttocks and perineal area. The following day she described abdominal bloating and weakness of the anal sphincter. These symptoms — including the loss of the urge to urinate and defecate — continued for roughly ten days until her discharge, yet the hospital performed no additional imaging and did not act on the signs of nerve compression. It was only on the day of discharge that the hospital raised the possibility of cauda equina syndrome and suggested simply observing her condition for about a week.

Three days after discharge, the client went to a different university hospital, where she was diagnosed with cauda equina syndrome. She underwent surgery under general anesthesia the next day to remove the protruding disc. Despite the operation, she was left with lasting impairments, including a neurogenic bladder that requires self-catheterization, bowel dysfunction, and reduced movement in her left ankle.

Medical Issue

Cauda equina syndrome is a medical emergency. When the bundle of nerves at the lower end of the spinal cord is compressed, early decompression surgery offers the best chance of recovery. A delay of even a short period can allow permanent damage to bladder, bowel, and lower limb function. The central medical question in this case was whether the hospital should have recognized the client's post-procedure symptoms sooner and ordered prompt imaging and surgery instead of waiting.

Key Legal Issues

Three issues dominated the litigation. First, hospital negligence in post-procedure care: the defense argued that the client's symptoms alone were not enough to identify cauda equina syndrome and that imaging was not strictly required, while Taeshin Law Firm countered that the symptoms appeared immediately after the procedure and persisted for about ten days without any follow-up testing. Second, informed consent: the consent form listed infection as a complication but did not mention the risk of nerve injury or cauda equina syndrome. Third, the scope of damages: the first-instance court did not account for the client's bowel dysfunction in its calculation of lost earning capacity and assessed the ankle impairment as lasting only ten years. The hospital also maintained that the procedure could not cause cauda equina syndrome and that the client's bladder and bowel problems resulted from her pre-existing disc condition worsening over time.

Taeshin's Approach

The firm built its case on the timeline of the client's symptoms and the hospital's failure to investigate them. Nursing records showed that the client's original back pain and leg numbness actually eased after the procedure — evidence that the new symptoms were not a natural worsening of her disc condition but rather the result of the procedure and the hospital's delayed response. The firm also submitted imaging from before the procedure and after the surgery to support causation.

Because the client's impairments spanned several medical specialties, the firm requested physical examinations in urology, gastroenterology, and rehabilitation medicine. When the first-instance bowel-function examination could not be completed, the firm obtained anorectal manometry records from a university hospital and used them on appeal to demonstrate reduced rectal sensation. It also relied on a first-instance medical-records appraisal stating that the roughly two-week period without specific testing or treatment likely contributed to the client's disability, and that earlier testing and emergency surgery would likely have produced a better prognosis.

Outcome

The first-instance court found the hospital negligent for failing to order testing and early surgery despite the client's post-procedure symptoms, and it also found a violation of the duty to obtain informed consent. Both sides appealed. The appellate court rejected the hospital's argument that the client's condition was a pre-existing worsening of her disc, newly recognized the bowel dysfunction as a permanent disability resulting in a 20% loss of earning capacity, and increased the award. After the hospital appealed further, the parties reached a settlement in which the hospital paid 340 million won and withdrew its appeal, bringing the matter to a close.

What This Case Shows

This case illustrates how quickly the legal analysis in a medical malpractice matter can turn on the timeline of care. A hospital's failure to investigate clear post-procedure symptoms — and a consent form that omits material risks — can support a finding of negligence even where the underlying procedure itself is not found to have been performed improperly. For families pursuing medical malpractice claims, it also shows the importance of multi-specialty medical evaluation in quantifying permanent impairments, and of persistence through appeal when a first-instance court undervalues a lasting injury.