Intraoperative spinal cord monitoring during the surgical correction of scoliosis due to cerebral palsy and other neuromuscular disorders.

PURPOSE: Patients with neuromuscular scoliosis are at increased risk of neurological deficit post-operatively, but are a difficult population on whom to perform neurophysiological monitoring. We look here at a 7-year sample of our practice in the monitoring of neuromuscular patients. METHODS: A retrospective chart review was performed for 109 patients who underwent correction of neuromuscular scoliosis within our institution between 2005 and 2011. RESULTS: Of 109 patients who were identified, intraoperative monitoring was attempted in 66 cases. In eight cases (13 %), no reliable monitoring could be achieved and was therefore abandoned. On nine occasions, there was a significant drop in at least one modality intraoperatively. None of these nine suffered any clinically observable neurological deficit post-operatively. Of the 109 patients, 2 had clinically detectable deficits post-operatively, both of whom had undergone normal intraoperative monitoring. CONCLUSIONS: The two patients with observable deficit had their instrumentation left in situ after discussion with them and/or parents. Spinal cord monitoring in this population is possible but potentially unreliable. Surgeons will need to carefully consider the use of monitoring in their management of this challenging population.

Malpractice litigation and the spine: the NHS perspective on 235 successful claims in England.

PURPOSE: The objective of this study was to evaluate the overall incidence and total burden of successful litigation relating to the management of spinal disease across the National Health Service (NHS) in England. METHODS: The study design comprised a retrospective review of the NHS Litigation Authority (NHSLA) database, retrieving all successful claims relating to spinal disease between 2002 and 2010--a total of 235 (144 acute, 91 elective). RESULTS: The general trend for successful claims with relation to spinal surgery has actually been decreasing steadily over the last few years. The total value of these claims during the period was £ 60.5 million, comprising £ 42.8 million (£ 28.6 million relating to acute diagnoses, £ 16.1 million for elective) in damages and £ 17.7 million in legal costs (31% relating to NHS legal costs, the remainder claimants costs). CONCLUSIONS: Spinal litigation remains a source of significant cost to the NHS. The complexity of resolving these cases is reflected in the associated legal costs.