1. Medicolegal suits associated with cervical spine surgery. Researchers posed questions about malpractice allegations that prompted lawsuits against a surgeon to 68 patients who received cervical spine surgery and published the results in Spine. Postoperative neurologic deficits that led to suits included quadriplegia in 41 patients.
Other injuries and lesser postoperative deficits in 15 patients and 22 patients had pain alone. Malpractice suits involved 63 spine surgeons, whereas 15 of the cases did not. The three most common malpractice events prompting cervical suits were negligent surgery, lack of informed consent and failure to diagnose or treat the condition. The fourth factor was failure to brace.
The outcomes for the suits included 30 defense verdicts, 22 plaintiffs’ verdicts with an average payout of $4 million and 26 settlements with an average payout of $2.4 million. The article suggests future consideration given to tort reform or no-fault malpractice system.
2. Nonfusion posterior stabilization of thoracolumbar fractures effective. Researchers examined 23 patients under the age of 40 with thoracolumbar or lumbar spine fractures. The patients were treated by the nonfusion method, and implants were removed at an average of 9.7 months after the initial fracture fixation. The method was shown effective in treating young and active patients.
After surgery, the height of the fractured bodies was maintained at the final 18-month follow-up. The initial mean sagittal angle was 17.2 degrees kyphosis and became 2.8 degrees lordosis after fixation of the fractures. The mean sagittal motion was 14.2 degrees in the sagittal plane and 13.1 degrees in the coronal plane at the final follow-up. These results were published in Spine.
3. Cervical spine surgery complications more frequent in trauma and spinal oncologic procedures. Data was collected on 121 patients who underwent cervical spine surgery at Thomas Jefferson University Hospital from May to Dec. 2008. The complications were graded for severity by a survey of spine surgeons and patients. An independent assessor also audited the complication incidence in the patient cohort. Data on the diagnosis, comorbidities, BMI, complications and length of stay were collected and considered during the analysis. The results were published in The Journal of Spinal Disorders & Techniques.
The overall incidence of early complications was 47.1 percent with a 40.5 percent incidence of minor complications and an 18.2 percent incidence of major complications. The major complications were greater in cases of infection (20 percent) and spinal oncologic procedures (30 percent). The total number of complications recorded was greater in cases of infection and neoplasm.
4. Minimally invasive microdiscectomy exposes surgeons to more radiation than the open procedure. Researchers measured the radiation exposure to the surgeon by utilizing digital dosimeters placed at the level of thyroid/eye, chest and dominant forearm. The average radiation exposure to the surgeon during open cases was 0.16±0.22 mR (thyroid/eye), 0.21±0.23 mR (chest) and 0.20±0.14 mR (hand).
For the minimally invasive cases, surgeons were exposed to 1.72±1.52 mR (thyroid/eye), 3.08±2.93 (chest) and 4.45±3.75 (hand). Additionally, surgeons standing in an adjacent substerile room during the open cases were exposed to 0.2 mR per case. A surgeon can perform 1,623 minimally invasive microdiscectomies to exceed the exposure limit for whole-body radiation, 8,720 cases for the lens of the eye and 11,235 cases for the hand. The results were published in Spine.
5. NFL players often return-to-play after lumbar discectomies. In all, 66 linemen (36 offensive and 30 defensive) were diagnosed with lumbar disc herniation and 52 were treated surgically. The players had an average body mass index of 35.4 and was approximately 27.6 years old.
Of the players treated surgically, 80.8 percent successfully returned to play, while 63.5 percent became starters after treatment. Among these players, 13.5 percent required revision decompression and 85.7 percent successfully returned to play. Only 2.86 percent of the players who received nonoperative intervention returned to play. The authors of the article, published in The American Journal of Sports Medicine, suggest that NFL linemen should not be denied surgical treatment after recurring problems in the lower back.
