Thurs., Dec.

4, 2008, 11:21 11:28 AM CSRS-2008

Paper #16

What Can We Learn from a Review of Medicolegal Malpractice Suits Involving Cervical
Spine Surgery?
Nancy E Epstein, MD, New Hyde Park, NY, USA (n)

I ntroduction: Medicolegal suits represent an untapped source of information about cervical

spine surgery. Here, we used a legal research service to answer the following questions: Who
was sued in cervical spine cases? What were the operations/deficits that lead to these suits?
What purported malpractice events prompted these suits?

Methods: Database Verdict Search is a legal research service for civil and criminal court cases
[verdicts, settlements, judgments]. Utilizing Verdict Search and 3 sets of key words, [1] cervical
spine surgery-quadriplegia, [2] cervical spine fusion-neurological deficits, and [3] cervical spine
surgery-medial malpractice, we identified 597 cases over the last 10 years. Of these, 78 cases
were directly related to cervical spine surgery, while the remainder predominantly addressed
other malpractice actions, motor vehicle accidents, and product/premises liability.

Clinical Information Of 78 patients [32 females and 46 males], 70 averaged 49.4 years of
age; age was unavailable in the other 8. Trauma contributed to pathology in 25 cases. A total
of 134 operations were performed [average 1.7; range 0-7]; 36 patients had one, 25 patients
had two, 4 patients had three, 3 patients had four, 1 patient had five, 2 patients had six, and
1 patient had 7 operations. First operations included 48 anterior and 20 posterior procedures:
1 level anterior diskectomy/fusion [ADF] [27], 2 level ADF [11], 3-4 level ADF [6], 1 level
anterior corpectomy/fusion [4], posterior fusion [7], and laminectomy/posterior fusion [13].
One circumferential operation [C6-C7], and 1 intramedullary cord injection completed the list
along with 8 cases involving pending surgery.

Results: Morbidity Forty-one patients were quadriplegic following their cervical surgical
procedures [1 death: carotid laceration]. Thirty-seven patients had lesser deficits [15], or pain
alone [22].

Who was sued? Sixty-three suits involved spine surgeons either alone or in a group [35], with
hospital(s) [10], with companies/product liability [4], or with adjunctive personnel [14]. Fifteen
suits did not include spine surgeons, but involved other specialists.

Why were they sued? Major overlapping reasons for suits following cervical surgery included:
negligent surgery [69], lack of informed consent [44], failure to diagnose/treat [37], and failure
to brace [26].

Verdicts vs. Settlements There were 26 settlements averaging $2.4 million dollars, 22 plaintiff
verdicts averaging $4.0 million dollars, and 30 defense verdicts. Cases were filed in California
[21], New York [16], Texas [9], Missouri [7], Florida [4], and 13 other states [1-3 cases/state].

The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug
or medical device is being discussed for an off label use). See inside back cover for full information.

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Conclusions: A review of medicolegal suits over the last 10 years yielded 78 cervical cases.
First, most suits were brought against spine surgeons alone or with hospitals, companies,
and adjunctive personnel; 19 % did not involve spine surgeons. Second, 41 patients with
quadriplegia, and 37 with lesser deficits [15] or pain alone [22], mainly underwent anterior
operations [48], predominantly single level ADF [27], followed by posterior procedures [20].
Third, malpractice suites were largely based upon surgical negligence, lack of informed consent,
failure to diagnose, and, surprisingly, failure to brace. Further work is needed to determine
whether the information here could improve patient care and/or enhance our understanding of
the behavior of plaintiffs lawyers.

If noted, the author indicates something of value received. The codes are identified as a-research or insti-
tutional support; b-miscellaneous non-income support/miscellaneous funding; c-royalties; d-stock or stock
options; e-consultant or employee; n-nothing of value received, and *disclosure not available at time of
printing. For full information refer to inside back cover.

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