Analysis of reasons for medical malpractice litigation due to anterior cervical discectomy and fusion

Haad Arif; Jacob Razzouk; Daniel Bohen; Omar Ramos; Olumide Danisa; Paul Cheng; Wayne Cheng

doi:10.1016/j.wnsx.2024.100371

Analysis of reasons for medical malpractice litigation due to anterior cervical discectomy and fusion

World Neurosurg X. 2024 Mar 29:23:100371. doi: 10.1016/j.wnsx.2024.100371. eCollection 2024 Jul.

Authors

Haad Arif¹, Jacob Razzouk², Daniel Bohen³, Omar Ramos⁴, Olumide Danisa⁵, Paul Cheng⁶, Wayne Cheng⁷

Affiliations

¹ School of Medicine, University of California, Riverside, Riverside, CA, USA.
² School of Medicine, Loma Linda University, Loma Linda, CA, USA.
³ Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA.
⁴ Department of Orthopaedic Surgery, Twin Cities Spine Center, Minneapolis, MN, USA.
⁵ Department of Orthopaedic Surgery, Loma Linda University, Loma Linda, CA, USA.
⁶ Law Offices of Paul Cheng & Associates, Pasadena, CA, USA.
⁷ Division of Orthopaedic Surgery, Jerry L Pettis Memorial Veterans Hospital, 25805 Barton Road Suite A106, Loma Linda, CA, 92354, USA.

Abstract

Background: Anterior cervical discectomy and fusions (ACDF) are among the most common cervical spine operations, with over 137,000 surgeries performed annually. Understanding reasons underlying malpractice pertaining to ACDF may inform physicians of practices to improve delivery of patient care and mitigate malpractice. The aim of our study was to analyze the causes and outcomes for lawsuits pertaining to ACDF.

Methods: The Westlaw Edge and Verdict Search databases were queried for malpractice claims utilizing the keywords "anterior cervical discectomy and fusion" and "ACDF". Inclusion criteria was based on relevance of case grievance(s) to ACDF. Data collected included date of case hearing, plaintiff demographics, defendant specialty, verdict ruling, location of filed claim, monetary award, and sustained injuries.

Results: Fifty cases were included in this study after excluding 1933 cases. Of the 50 cases, 34 (68%) resulted in a defendant outcome, 8 (16%) resulted in a plaintiff outcome, and 8 (16%) resulted in settlement. Plaintiff verdicts resulted in an average monetary payment of $9.70 million, while settlements resulted in an average payment of $2.06 million. Reasons for litigation were divided into 10 categories, most commonly improper postoperative management (20%), hardware failure (18%), intraoperative error (14%), off-label use of implants (14%), and insufficient informed consent (12%).

Conclusions: Malpractice claims due to ACDF are associated with higher frequencies of plaintiff verdicts and higher monetary costs compared to other spinal surgery procedures. There does not appear to be supporting evidence that spinal cord neuromonitoring is mandatory for ACDF procedures from a medicolegal standpoint.

Keywords: Anterior cervical discectomy and fusion; Litigation; Malpractice; VerdictSearch; Westlaw.