Medical Malpractice Claims Following Incidental Durotomy Due to Spinal Surgery
Wesley M Durand1, Adam E M Eltorai, Govind Shantharam
1Department of Orthopedics, Division of Spine Surgery, Brown University Warren Alpert Medical School, Providence, RI.
Study Design:
Retrospective cohort study.
Objective:
Analyze medical malpractice verdicts and settlements associated with incidental durotomy.
Summary Of Background Data:
Incidental durotomy is a common complication of spine surgery. Although most intraoperative dural tears are repaired without sequelae, persistent Cerebrospinal Fluid leak, infection, or neurological injury can yield adverse outcomes. The medicolegal implications of incidental durotomy are poorly understood.
Methods:
Three separate, large legal databases were queried for cases involving incidental durotomy. Case, plaintiff, procedure, and outcome characteristics were analyzed.
Results:
In total, 48 dural tear-related medical malpractice cases were analyzed. Most cases (56.3%) resulted in a ruling in favor of the defendant physician. Most cases alleged neurological deficits (86.7%). A large majority of cases without neurological sequelae had an outcome in favor of the defendant (83.3%). For cases involving a payment, the average amount was $2,757,298 in 2016 adjusted dollars. Additional surgery was required in 56.3% of cases, a delay in diagnosis/treatment of durotomy was present in 43.8%, and alleged improper durotomy repair was present in 22.9%. A favorable outcome for the plaintiff was more likely in cases with versus without alleged delay in diagnosis/treatment (61.9% vs. 29.6%, P = 0.025) and improper durotomy repair technique (72.7% vs. 35.1%, P = 0.040). Repeat surgery was not associated with favorable outcome for the plaintiff (42.8% cases with reoperation vs. 38.1% without, P = 0.486).
Conclusion:
This analysis of durotomy-associated closed malpractice claims after spine surgery is the largest yet conducted. Durotomy cannot always be considered an entirely benign event, and these findings have several direct implications for clinicians: late-presenting or dehiscent durotomy may be associated with adverse outcomes and subsequent risk of litigation, timely reoperation in the event of durotomy-related complications may not increase surgeon liability, and spine surgeons should be prepared to defend their choice of durotomy repair technique, should dehiscence occur.
Level Of Evidence:
3.
Insights
Incidental durotomy during spine surgery can lead to malpractice claims, especially with delayed diagnosis or improper repair. Most cases favor the surgeon, but awareness of risks and proper technique is crucial for avoiding litigation.
Area of Science:
- Neurosurgery
- Medical Malpractice Law
- Spine Surgery Complications
Background:
- Incidental durotomy is a frequent complication during spine surgery.
- While often repaired without issue, dural tears can lead to persistent cerebrospinal fluid leaks, infections, or neurological deficits, with poorly understood medicolegal consequences.
Purpose of the Study:
- To analyze medical malpractice verdicts and settlements related to incidental durotomy in spine surgery.
- To understand the medicolegal implications and outcomes of incidental durotomy.
Main Methods:
- A retrospective cohort study analyzing 48 medical malpractice cases involving incidental durotomy.
- Data were extracted from three large legal databases, examining case, plaintiff, procedure, and outcome characteristics.
Main Results:
- Most cases (56.3%) ruled in favor of the defendant physician, with neurological deficits alleged in 86.7%.
- Favorable plaintiff outcomes were linked to delayed diagnosis/treatment (61.9%) and improper repair technique (72.7%).
- Average payment in cases with a plaintiff award was $2,757,298 (2016 adjusted dollars).
Conclusions:
- Incidental durotomy is not always benign and carries litigation risk.
- Timely reoperation for complications may not increase surgeon liability.
- Surgeons must be prepared to defend their dural repair techniques.
