Trends and Risk Factors for Malpractice Litigation in Spinal Neurosurgery

Introduction: An understanding of malpractice trends is important for insurance planning and may help neurosurgeons mitigate the risk of litigation. The present study sought to characterize nationwide litigation patterns in spinal neurosurgery.

Methods: The Westlaw Edge database was queried for medical malpractice cases, filed between January 2000 and September 2024, involving spinal neurosurgery. Data collected included: verdict outcomes, award values, practice settings, surgical characteristics (pathology and procedure), and reasons for litigation.

Results: Of 3,692 cases reviewed, 274 were included. Of the included cases, 174 cases (63.5%) resulted in a defendant ruling, 69 (25.2%) in a plaintiff ruling, and 27 (9.9%) in settlement. Median awards were $1,219,052 for plaintiff rulings and $1,103,750 for settlements. The largest award for a plaintiff ruling was $38.3 million USD, and the largest settlement amount was $28.0 million USD. Private practice accounted for 48.5% of cases (n = 133) and 56.5% (n = 155) of plaintiff verdicts; academic centers accounted for 28.9% (n = 79) of cases but only 14.5% (n = 40) of plaintiff verdicts. Most cases related to lumbar (102 cases, 37.2%) and cervical (93 cases, 33.9%) procedures. The most common litigation categories were intraoperative complications (88 cases, 32.1%), postoperative complications (27 cases, 9.9%), and incorrect procedure selection (27 cases, 9.9%). With respect to etiology, degenerative pathology was the most common (131 cases, 47.8%), followed by trauma (36 cases, 13.1%) and tumor (10 cases, 3.6%).

Conclusion : Although most cases rule in favor of the defendant, plaintiff rulings/settlements can result in considerable awards. An understanding these patterns can guide risk management in spinal neurosurgery.