Medical Malpractice Litigation in Spine Surgery: A Systematic Review

Spine surgery is a high-risk specialty for litigation, with most practicing surgeons encountering at least 1 malpractice claim during their careers. This systematic review aimed to evaluate the trends and characteristics of medical malpractice claims after spine surgery.

A systematic search was conducted on PubMed, Scopus, Embase, and Web of Science to find studies reporting on patients who underwent spine surgery and sued their surgeons. Studies that included original extractable data on litigation after spine surgery were included without date or geographical restrictions. Outcome measures included demographic details, anatomic regions, diagnosis, procedure, verdict, defendant's specialty, reason for litigation, patient injuries or damages, and payouts. Two reviewers independently screened and selected the articles. The protocol was prospectively registered on PROSPERO.

This review reports on 5,514 malpractice cases in 54 studies covering 1968 to 2023. Most of the literature has been published in the United States (28/54 studies). The numbers of males (n = 1,192, 50.6%) and females (n = 1,166, 49.4%) were almost equal. Most patients had undergone lumbar spine surgery (53.9%), followed by cervical (26.6%) spine surgery. Most surgeries were performed electively (70.9%), with a minority (29.1%) being emergent surgeries. The top 3 common alleged reasons for litigation were (1) delay or failure to diagnose or treat (1,380 cases), (2) intraoperative/procedural error (901 cases), and (3) inadequate informed consent (694 cases). The top 3 common injuries reported were (1) new neurological deficit, that is, nerve or spinal cord injury (1,423 cases); (2) persistent pain or suffering (585 cases); and (3) additional surgery required (381 cases). Most cases concluded with either a defense verdict (56.8%) or settlement (11.1%), with only 29.3% resulting in a plaintiff verdict. Orthopaedic surgeons represented 47.1% of the providers sued, whereas 35.9% were neurosurgeons. Payouts resulting from plaintiff verdicts were significantly higher than payouts in settlement (mean difference = $1,304,100, 95% confidence interval $93,430-$2,514,780, p = 0.01).

The most common reason for litigation after spine surgery is a new neurological deficit, mainly resulting from a delay in diagnosis or treatment, intraoperative error, or inadequate informed consent. Emphasizing communication and informed consent is an effective method of improving patient care and decreasing litigation.

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.