Durotomy: A common complication of spinal surgery—and an important factor in some malpractice cases

December 4, 2017, Wolters Kluwer Health

Incidental durotomy—small tears of the outer membrane of the spinal cord—are a common occurrence in spinal surgery, and may lead to litigation. Most malpractice cases associated with dural tear end in a ruling in favor of the surgeon, reports a study in the journal Spine.

But certain types of durotomy cases are more likely to resolved in favor of the patient—especially when durotomy is detected late or causes more-severe injury, according to the new research. The lead author is Wesley M. Durand, ScB, a medical student at Brown University, Providence, R.I.

Durotomy in Malpractice Cases - What Factors Affect the Verdict?

In a search of three legal databases, the researchers identified 48 malpractice cases involving "incidental durotomy" during . Incidental durotomy refers to unintended tears or puncture of the dura mater: the tough covering the spinal cord. Dural tears occur frequently during spinal ; when promptly recognized and repaired, they generally cause no long-term problems.

However, complications can ensue if the dural tear is not repaired, or if it reopens after surgery (dehiscence). The researchers evaluated the outcomes of malpractice cases involving incidental durotomy, and factors associated with which way the case was decided. All 48 cases were resolved by verdict or settlement.

The with incidental durotomy were 24 men and 24 women, average age 55 years. Allegations included the need for additional surgery, delayed diagnosis/treatment, and/or improper durotomy repair. Injury severity included weakness in about 60 percent of cases and paralysis, , or death in 20 percent.

Most cases—about 56 percent—resulted in a verdict in favor of the physician or surgeon (defendant). That included more than 80 percent of cases not involving neurologic complications, such as weakness or brain damage.

The remaining 44 percent of malpractice cases were settled or decided in favor of the patient or family (plaintiff). In cases involving a payment, the average amount was about $2.8 million (in 2016-adjusted dollars). Male plaintiffs were more likely to receive a favorable decision.

On its own, the need for further surgery to repair a dural tear did make it more likely that the patient would receive a favorable settlement or verdict. But a decision favoring the patient was more likely in cases with alleged delay in diagnosis/treatment, 62 percent; or improper repair, 73 percent.

The study helps to clarify the medicolegal aspects of durotomy-related verdicts and settlements. That's especially important because incidental durotomy is such a common—sometimes unavoidable—occurrence in spinal surgery.

The findings underscore that, from a legal standpoint, surgeons should not consider durotomy "an entirely benign event." Surgeons are more likely to prevail in cases where a dural tear is promptly recognized and treated, and when durotomy causes minor, non-neurological injuries. In contrast, a decision in favor of the patient is more likely if the durotomy goes unrecognized, results in more severe injuries, or reopens after repair. "These findings may be important for future tort reform," the researchers write.

Explore further: Peri-op management key in surgical resident malpractice

More information: Wesley M. Durand et al. Medical Malpractice Claims Following Incidental Durotomy Due to Spinal Surgery, SPINE (2017). DOI: 10.1097/BRS.0000000000002469

Related Stories

Peri-op management key in surgical resident malpractice

September 4, 2017
(HealthDay)—The perioperative period appears critical in malpractice cases involving surgical residents, according to a study published online Aug. 30 in JAMA Surgery.

Rhytidectomy litigation usually resolved in defendant's favor

February 10, 2017
(HealthDay)—Most cases of rhytidectomy malpractice litigation are resolved in the defendant's favor, according to research published online Feb. 9 in JAMA Facial Plastic Surgery.

Study examines malpractice litigation in peds ophthalmology

September 6, 2016
(HealthDay)—In ophthalmology medical malpractice litigation, cases involving pediatric versus adult patients are more likely to result in verdicts in favor of the plaintiff and have higher jury awards and indemnity payments, ...

Massachusetts primary care malpractice claims related to alleged misdiagnoses

September 30, 2013
Most of the primary care malpractice claims filed in Massachusetts are related to alleged misdiagnoses, according to study in JAMA Internal Medicine by Gordon D. Schiff, M.D., of the Harvard Medical School and Brigham and ...

Study examines trends in tracheotomy malpractice suits

January 15, 2015
(HealthDay)—Malpractice litigation relating to complications from tracheotomies can result in high award amounts, especially in pediatric cases, according to a study published online Dec. 18 in Head & Neck.

Informed consent plays major role in prostatectomy lawsuits

May 29, 2014
(HealthDay)—Claims of not receiving proper informed consent and clinical performance are the main issues that arise in radical prostatectomy malpractice litigation, according to a study published in the June issue of The ...

Recommended for you

Amount of weight regain after bariatric surgery helps predict health risks

October 16, 2018
Measuring the percentage of weight regained following the maximum amount of weight lost after bariatric surgery can help predict a patient's risk of several serious health problems, according to a long-term, multicenter study ...

Technique to 'listen' to a patient's brain during tumour surgery

October 16, 2018
Surgeons could soon eavesdrop on a patient's brain activity during surgery to remove their brain tumour, helping improve the accuracy of the operation and reduce the risk of impairing brain function.

Researchers link gut bacteria to heart transplant success or failure

October 4, 2018
In a new study, researchers at the University of Maryland School of Medicine (UMSOM) have found that the gut microbiome appears to play a key role in how well the body accepts a transplanted heart. The scientists found a ...

Focus on neuroscience, nociception to improve anesthesia, paper says

October 1, 2018
People sometimes mistakenly think of general anesthesia as just a really deep sleep but in fact, anesthesia is really four brain states—unconsciousness, amnesia, immobility and suppression of the body's damage sensing response, ...

Bariatric surgery linked to safer childbirth for the mother

September 27, 2018
Obese mothers who lose weight through bariatric surgery can have safer deliveries. The positive effects are many, including fewer caesarean sections, infections, tears and haemorrhages, and fewer cases of post-term delivery ...

Antibiotics for appendicitis? Surgery often not needed

September 25, 2018
When emergency tests showed the telltale right-sided pain in Heather VanDusen's abdomen was appendicitis, she figured she'd be quickly wheeled into surgery. But doctors offered her the option of antibiotics instead.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.