European Spine Journal

, Volume 27, Issue 11, pp 2693–2699 | Cite as

Can spinal surgery in England be saved from litigation: a review of 978 clinical negligence claims against the NHS

  • John T. Machin
  • John HardmanEmail author
  • William Harrison
  • Timothy W. R. Briggs
  • Mike Hutton
Original Article



The aim of this study is to evaluate the true incidence of all clinical negligence claims against spinal surgery performed by orthopaedic spinal surgeons and neurosurgeons in the National Health Service (NHS) in England, including both open and closed claims.


This study was a retrospective review of 978 clinical negligence claims held by NHS Resolution against spinal surgery cases identified from claims against ‘Neurosurgery’ and ‘Orthopaedic Surgery’. This category included all emergency, trauma and elective work and all open and closed cases without exclusion between April 2012 and April 2017.


Clinical negligence claims in spinal surgery were estimated to cost £535.5 million over this five-year period. There is a trend of both increasing volume and estimated costs of claims. The most common causes for claims were ‘judgement/timing’ (512 claims, 52.35%), ‘interpretation of results/clinical picture’ (255 claims, 26.07%), ‘unsatisfactory outcome to surgery’ (192 claims, 19.63%), ‘fail to warn/informed consent’ (80 claims, 8.13%) and ‘never events’ including ‘wrong site surgery’ or ‘retained instrument post-operation’ (26 claims, 2.66%). A sub-analysis of 3 years including 574 claims revealed the most prevalent pathologies were iatrogenic nerve damage (132 claims, 23.00%), cauda equina syndrome (CES) (131 claims, 22.82%), inadequate decompression (91 claims, 15.85%), iatrogenic cord damage (72 claims, 12.54%), and infection (51 claims, 8.89%).


The volume and costs of clinical negligence claims is threatening the future of spinal surgery. If spinal surgery is to continue to serve the patients who need it, most thorough investigation, implementation and sharing of lessons learned from litigation claims must be systematically carried out.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Litigation Negligence Malpractice Medicolegal 


Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Supplementary material

586_2018_5739_MOESM1_ESM.pptx (143 kb)
Supplementary material 1 (PPTX 143 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018
corrected publication October 2018

Authors and Affiliations

  1. 1.Nottingham University Hospitals NHS Trust, Chesterfield Royal Hospital NHS Foundation TrustNHS ImprovementLondonUK
  2. 2.Whittington Health NHS TrustLondonUK
  3. 3.Mersey DeaneryLiverpoolUK
  4. 4.The Royal National Orthopaedic Hospital (Stanmore) NHS TrustNHS ImprovementLondonUK
  5. 5.Royal Devon and Exeter NHS Foundation TrustExeterUK

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