Medical-legal aspects and risk management

Abstract

Complications of spinal surgery are an important source of professional liability judgments for trauma surgeons and neurosurgeons who develop this subspecialty. The disc pathology leads all the rankings of claims against these professionals. [1,2,3] This situation does not attract attention, given that lumbar and cervical disc hernias are frequent affections and more and more surgeons are turning to this activity. For the current neurosurgeon, the pathology of the spine tends to represent 50% of its benefits [4]. The high cost of agreements and sentences in cases of spinal surgeries is a reflection of the infrequent but severe damage that can occur when working millimeters from the spinal cord and nerve roots. Spine surgery has all the ingredients that can make a trial a nightmare. In general, patients with pathologies that do not threaten life, where the main symptom (pain) has a strong subjective component and where often the opinions of experts differ between conservative and radical approaches. There are several alternatives that are not always adequately reported to the patient, who may be surprised at evolutions that were not anticipated. On the other hand, in the case of quadriplegic or paraplegic patients, the costs of lost profits and future expenses are usually millionaires [5,6,7,8]. It is an extensive, varied and complex discipline and there are many authors who suggest the need to convert it into a new specialty [4] [9,10]. Spinal surgery is technically difficult and acquiring the necessary skills demands years of learning. The margin of error is minimal and only careful attention to detail in the pre, intra and postoperative ensures consistent good results. When complications arise and judgments for professional responsibility, the rush in the surgical decision (except in cases of clear urgency) and the lack of adequate information to the patient are usually aspects widely debated by all parties.