Litigation in Spine Surgery: Why Were We Sued? To What Results? What Can We Learn?

Spine surgery is highly prone to litigation due to unpredictable functional outcomes and neurological complication risks, despite complication rates being lower than those of other orthopaedic subspecialities. Data on spine litigation dynamics in India are limited, with most studies originating from North America and China. We aimed to evaluate factors leading to litigation against spine surgeons in India, litigation outcomes, and lessons for reducing litigation risk.

A retrospective descriptive study was conducted by searching Indian Kanoon and confonet.nic.in for "spine surgery" judgements over 20 years, yielding 69 eligible cases after exclusions. Variables studied included litigant demographics, disease aetiology, surgical details, alleged deficiencies, verdicts, compensation, hospital type, and surgeon speciality. Statistical analysis was performed using SPSS with Chi-square tests for categorical data.

Of 69 litigations, 69.5% of plaintiffs were male, and 92.75% of cases were against private practitioners. Orthopaedic surgeons were involved in 53.6% of cases, and neurosurgeons in 43.5%. Guilty verdicts occurred in 42% of cases. Common litigation triggers included postop neural deficits (30.4%), symptom non-relief (26%), delayed diagnosis (24.6%), and infection (23.2%). Wrong-level surgery had the highest likelihood of a guilty verdict (83%). Elective, basic spine surgeries, such as lumbar discectomy (46.9%), were most frequently litigated. The average compensation awarded was ₹8.27 lakh, significantly lower than the demands.

Recognising litigation trends and adopting comprehensive preoperative counselling, meticulous documentation, and prompt management of complications can reduce litigation risk while enhancing patient safety and care quality in spine surgery practice.