Scoliosis and litigation

Abstract

In 2010/2011, 2053 spinal infusions were carried out for scoliosis, of which 1328 were in children. In contrast there were 224 549 admissions in total for spinal disorders1 and therefore scoliosis cases proceeding to litigation are relatively uncommon. There may be other reasons for the lower incidence of litigation in scoliosis patients including the fact that almost all of these operations are carried out in tertiary centres as planned cases during daylight hours. Multidisciplinary teams of surgeons, physicians and other healthcare professionals manage the patients, and in many cases two senior surgeons operate together which may reduce the risks in these cases. Furthermore, the consenting process is generally carried out by more senior members of the team; the patients and their families are usually in no doubt that this is a major operation not without significant risk, and patients are rarely given the impression that complete correction of the deformity will take place. Although curve progression and prevention of pain are the main indications for surgery, improvement in cosmesis is also an important aim of the surgery. However, I am not aware that failure to improve appearance has been a cause for litigation. The majority of claimants in scoliosis cases are children and their families. Because many operations are carried out early in childhood, there is a very long trail of cases. Adults have to commence proceedings within three years of the perceived injury, while children have until the age of 21 to do so. In many cases the surgeon in charge of the case may be retired or may have died. The causes of allegations of negligence/breach of duty include neurological injury; failure of instrumentation or other instrumentation problems; nonunion of fusion; choice of wrong levels; failure to identify pre-operative abnormalities; failure to use spinal cord monitoring; failure …