Descriptive Analysis of State and Federal Spine Surgery Malpractice Litigation in the United States.

STUDY DESIGN: A retrospective review. OBJECTIVE: This study aimed to determine the factors associated with malpractice litigation in cases involving spine surgery in the United States. SUMMARY OF BACKGROUND DATA: Medical malpractice is of substantial interest to the medical community due to concerns of increased health care costs and medical decision-making for the sole purpose of reducing legal liability. METHODS: The Westlaw online legal database (Thomson Reuters, New York, NY) was searched for verdict and settlement reports pertaining to spine surgery from 2010 to 2015. Data were collected regarding type of procedure, patient age and gender, defendant specialty, outcome, award, alleged cause of malpractice, and factors involved in the plaintiff's decision to file. Initial search queried 187 cases, after which exclusion criteria were applied to eliminate duplicates and cases unrelated to spine surgery, yielding a total of 98 cases for analysis. RESULTS: The verdict was in favor of the defendant in 62 cases (63.3%). Neurosurgeons and orthopedic surgeons were the most common defendants in 29 (17.3%) and 40 (23.8%) of the cases, respectively. A perceived lack of informed consent was noted as a factor in 24 (24.4%) of the cases. A failure to diagnose or a failure to treat was noted in 31 (31.6%) and 32 (32.7%) cases, respectively. Median payments for plaintiff verdicts were nearly double those of settlements ($2,525,000 vs. $1,300,000). A greater incidence of plaintiff verdicts was noted in cases in which a failure to treat (P < 0.05) was cited, a patient death occurred (P < 0.05), or an emergent surgery had been performed (P < 0.01). CONCLUSION: Overall, physicians were not found liable in the majority of spine surgery malpractice cases queried. LEVEL OF EVIDENCE: 4.

Apresentação atípica de hérnia discal cervical sequestrada / Unusual presentation of sequestered cervical disc herniation

Pacientes portadores de hérnias de disco cervicais podem ser estar assintomáticos ou cursarem com quadros de radiculopatia ou mielopatia cervical. Geralmente, elas estão situadas anterior ou antero-lateralmente no espaço epidural. Apresentamos um caso de hérnia de disco cervical extrusa com migração dorsolateral no canal, mimetizando uma lesão tumoral extradural.Acredita-se que a ausência das articulações de Luschkano nível C7-T1 favoreça a migração dorsal da hérnia neste nível. O diagnóstico diferencial de lesões extradurais dorsolaterais com herniações de núcleo pulposo cervicais deve ser considerado no planejamento cirúrgico desses pacientes.