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Medical Malpractice Claims Following Incidental Durotomy Due to Spinal Surgery

Durand, Wesley M. ScB; Eltorai, Adam E. M. MSc; Shantharam, Govind BA; DePasse, J. Mason MD; Kuris, Eren O. MD; Hersey, Alicia E. BA; Palumbo, Mark A. MD; Daniels, Alan H. MD

doi: 10.1097/BRS.0000000000002469
Health Services Research: PDF Only

Study Design. Retrospective cohort study.

Objective. Analyze medical malpractice verdicts and settlements associated with incidental durotomy.

Summary of Background Data. Incidental durotomy is a common complication of spine surgery. While most intraoperative dural tears are repaired without sequelae, persistent CSF leak, infection, or neurological injury can yield adverse outcomes. The medicolegal implications of incidental durotomy are poorly understood.

Methods. Three separate, large legal databases were queried for cases involving incidental durotomy. Case, plaintiff, procedure, and outcome characteristics were analyzed.

Results. In total, 48 dural tear-related medical malpractice cases were analyzed. Most cases (56.3%) resulted in a ruling in favor of the defendant physician. Most cases alleged neurological deficits (86.7%). A large majority of cases without neurological sequelae had an outcome in favor of the defendant (83.3%). For cases involving a payment, the average amount was $2,757,298 in 2016 adjusted dollars. Additional surgery was required in 56.3% of cases, a delay in diagnosis/treatment of durotomy was present in 43.8%, and alleged improper durotomy repair was present in 22.9%. A favorable outcome for the plaintiff was more likely in cases with vs. without alleged delay in diagnosis/treatment (61.9% vs. 29.6%, p = 0.025) and improper durotomy repair technique (72.7% vs. 35.1%, p = 0.040). Repeat surgery was not associated with favorable outcome for the plaintiff (42.8% cases with reoperation vs. 38.1% without, p = 0.486).

Conclusions. This analysis of durotomy-associated closed malpractice claims following spine surgery is the largest yet conducted. Durotomy cannot always be considered an entirely benign event, and these findings have several direct implications for clinicians: 1) late-presenting or dehiscent durotomy may be associated with adverse outcomes and subsequent risk of litigation, 2) timely reoperation in the event of durotomy-related complications may not increase surgeon liability, 3) spine surgeons should be prepared to defend their choice of durotomy repair technique, should dehiscence occur.

Level of Evidence: 3

Department of Orthopedics, Division of Spine Surgery, Brown University Warren Alpert Medical School. 100 Butler Drive, Providence, RI 02906.

Address correspondence and reprint requests to Wesley M. Durand, ScB, Department of Orthopaedics, Division of Spine Surgery, Brown University Warren Alpert Medical School, 100 Butler Drive, Providence, RI 02906; E-mail: wesleymdurand@gmail.com

Received 16 August, 2017

Accepted 16 October, 2017

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: grants, royalties.

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