Legal spine

BACKGROUND: Given the increased attention to functional improvement in spine surgery as it relates to activities of daily living and cost, it is critical to fully understand the health care economic impact of enabling technologies. The use of intraoperative neuromonitoring (IOM) during spine surgery has long been controversial. Questions pertaining to utility, medico-legal considerations, and cost-effectiveness continue to be unresolved. The purpose of this study is to determine the cost-effectiveness by assessing quality-of-life due to adverse events averted, decreased postoperative pain, decreased revision rates, and improved patient reported outcomes (PROs)...

Introduction As the use of facet joint injections (FJI) increases, practitioners performing FJI may be at increased risk of legal liability. Malpractice claim analysis is performed by several specialties as it provides valuable insight into patient values and methods to mitigate the risk of malpractice litigation pertaining to a specific procedure or treatment. Malpractice analysis regarding FJI may provide clinicians with a better understanding of the reasons that lead to malpractice due to FJI, thereby allowing practitioners to improve the quality of care delivered to patients whilst mitigating the incidence of malpractice...

In the early morning a 28-year-old man was found lying on the tracks of a railway station with head injuries and fractures of the cervical spine resulting in permanent quadriplegia. He was in a club about 1 km away until about 2 h earlier and did not have any recollection of what could have happened. Was he the victim of an assault, did he fall down or was he hit by a passing train? The solution to this "mystery" came from a forensic evaluation that included the forensic branches of pathology, chemistry, merceology and genetics as well as the scene evaluation...

PURPOSE: In the last 20 years, the number of fatalities due to road traffic accidents (RTA) in Germany has steadily decreased from 7503 to 2724 per year. Due to legal regulations, educational measures and the continuous development of safety technology the number of severe traumatic injuries and injury patterns are most likely to change. The aim of the study was to analyse severely injured motorcyclists (MC) and car occupants (CO) that were involved in RTAs in the last 15 years and investigate the development and changes of injury patterns, injury severity and hospital mortality...

Postmortem CT has limitations in identifying cervical spine injuries. Injuries at the level of the intervertebral disc (anterior disc space widening), such as rupture of the anterior longitudinal ligament or intervertebral disc, may be difficult to distinguish from normal images depending on the imaging position. We performed postmortem kinetic CT of the cervical spine in the extended position in addition to CT in the neutral position. The difference in intervertebral angles between the neutral and extended positions was defined as the intervertebral range of motion (ROM), and the utility of postmortem kinetic CT of the cervical spine for the diagnosis of anterior disc space widening and its objective index were examined based on the intervertebral ROM...

Spinal trauma is an important cause of disability worldwide. Injury to the cervical spine (CS) occurs frequently after major trauma. 5-10% of patients with blunt trauma have a cervical spine injury. The cervical spine accounts for ~ 50% of all spinal injuries. Determination of CS stability is a common challenge in the acute care setting of patients with trauma. Several issues, indeed, are of particular concern: who needs CS imaging; what imaging should be obtained; when should computed tomography (CT), magnetic resonance imaging (MRI), or flexion/extension (F/E) radiographs be obtained; and how is significant ligamentous injury excluded in the comatose patient...

BACKGROUND: Approximately 80% of hip and knee surgeons will face malpractice litigation. Understanding contemporary reasons for litigation and legal outcomes in our field may help surgeons deliver more effective and satisfying care, while limiting their legal exposure. This study aimed to determine: 1) which orthopaedic subspecialties were most frequently litigated; 2) malpractice damages and negligence claimed; 3) the proportion of different case outcomes; and 4) factors associated with defense verdicts...

Background: Disability assessment is a critical component in getting a comprehensive and amicable compensation in medico-legal cases. The data regarding acquired disability among the hospital-admitted patients are lacking. The purpose of this study was to determine the demographic profile of disability-assessed patients in tertiary care hospitals in Coastal Karnataka, India between 2010 and 2019. The study also aims to evaluate the pitfalls in the present assessment method. Materials and Methods: A record-based retrospective study of all the cases assessed by the investigator in tertiary care hospitals in Coastal Karnataka between 2010 and 2019 was analyzed...

Oxelytrum discicolle is a necrophagous beetle occurring in Central and South America, with potential use in forensic entomology for investigations in the context of legal medicine. The present work aimed to describe the morphology of the digestive tract of larvae and adults and contributes to the knowledge about the digestion associated with necrophagy. In the three larval instars, the foregut is short and narrow, the midgut is a dilated tube, elongated with a smooth surface, and the hindgut is narrow and long, with small lateral projections and a dilated terminal region...

Cauda equina syndrome (CES) is a serious neurologic state in which neurological dysfunction affects the lumbar and sacral nerve roots within the vertebral canal. The nerves of the cauda equine provide the muscles that manage the bladder, bowel and the legs and the dysfunction producing impairment of bladder, bowel or sexual function and perianal or saddle numbness. Identification of CES is not only important to neurosurgeons and spine surgeons, but also to prime care practitioners, emergency room physicians, physiotherapists and allied health care professionals concerned in management of back pain...

We write as experienced paediatric practitioners who have been involved in medico-legal proceedings where cases related to childhood cancer practice have featured frequently. We will use the service evaluation of Professor David A Walker's last 35 cases, where all but seven concerned children with tumours of the brain or spine to illustrate the concerns that families raise. We refer to the evidence from the HeadSmart programme (www.headsmart.org.uk), which seeks to accelerate diagnosis by raising awareness of the disease and symptoms...

Even at low to moderate-speeds, rear-end motor vehicle crashes have been strongly associated with occupant cervicocranial biomechanics that lead to head and neck injury. In this paper, we present the development of an analytic mechanics model of occupant head and neck motion as associated with modeled target vehicle Delta V during rear-end vehicular crashes. The inclusion of stochastic mechanical input variables further developed the model beyond the deterministic framework by reflecting aspects of the random nature of real-world crashes and the resulting injuries...

BACKGROUND CONTEXT: Sports-related spinal injuries can be catastrophic in nature. Athletes competing in collision sports (e.g., football) may be particularly prone to injury given the high-impact nature of these activities. Due to the profound impacts on health and quality-of-life, sports-related spinal injuries are also associated with a risk of litigation. However, no study to date has assessed litigation risks associated with sports-related spinal injuries. A better understanding of the risk factors surrounding these legal claims may provide insights into injury prevention and strategies to minimize litigation risks...

BACKGROUND: Liver is the most common organ to get injured in cases of blunt force trauma to the abdomen (BFTA). It is the 2nd commonest organ after brain to sustain injuries out of all the trauma related fatalities. However, the literature about contre-coup injuries to the liver due to BFTA is scarce in-spite of the high mortality rates seen out of injury to this particular organ. PURPOSE: The authors intended to systematize the characteristic morphogenesis of the contre-coup injuries of the liver on the basis of the patho-mechanics involved in various types of BFTA...

STUDY DESIGN: Retrospective Cohort Study. OBJECTIVE: To determine if 1) preoperative marijuana use increased complications, readmission, or reoperation rates following anterior cervical discectomy and fusion (ACDF), 2) identify if preoperative marijuana use resulted in worse patient-reported outcome measures (PROMs), and 3) investigate if preoperative marijuana use affects the quantity of opioid prescriptions in the perioperative period. SUMMARY OF BACKGROUND DATA: A growing number of states have legalized recreational and/or medical marijuana, thus increasing the number of patients who report preoperative marijuana use...

OBJECTIVE: The aim was to investigate the extent of cauda equina syndrome (CES) litigation and explore the process of medico-legal litigation in relation to physiotherapy in the UK. DESIGN: A multimethods inquiry that followed on from a previously conducted scoping literature review was undertaken to address the aim. This included freedom of information requests and direct communication with relevant stakeholders and organisations. RESULTS: A total of 2496 CES claims were found in the UK between 2012 and 2020...

OBJECTIVE: Our research groups have studied the movement and injury characteristics of the human body in a side collision between the front of a small car and a pedestrian. This study discusses the movement and injury characteristics of the human body in a side collision between the front of a small car and bicycle. METHODS: A total of 31 cases of traffic accidents caused by small car collisions when riding a bicycle across a road were collected. Through on-site inspection and trace inspection of the accident vehicles and bicycles, the speed of the car during the collision was calculated, the collision relationship between the small car and bicycle was determined, and the injury site and degree were determined through autopsy...

INTRODUCTION: Extensive literature exists concerning the etiology and morphology of fractures of the hyoid bone (h.b.) in cases of fatal strangulation. There is an agreement to the effect that fractures are mostly located within the distal third of the cornua majora (c.m.). Although several predictors have been described very accurately, the fracture analysis has neither been based on the osseous construction nor on the stress distribution of the c.m. under strangulation resulting from the configuration and its details...

INTRODUCTION: When consulting a specialist in orthopaedics and trauma surgery, personal assessment and manual clinical examination by the doctor on site are essential. Nevertheless, implementation of video consultation hours has been made legally easier in Germany. The present pilot study examines the possibility of video-based assessment of the urgency of treatment in outpatient orthopaedic and trauma patients. MATERIALS AND METHODS: Within an ex ante study design, 40 patients with an orthopaedic clinical picture for trauma surgery with elective, urgent or emergency indication were selected from consultation hours...

BACKGROUND CONTEXT: In the U.S., medical malpractice litigation is associated with significant financial costs and often leads to the practice of defensive medicine. Among medical subspecialities, spine surgery is disproportionately impacted by malpractice claims. PURPOSE: To provide a comprehensive assessment of reported malpractice litigation claims involving elective lumbar spinal fusion (LSF) surgery during the modern era of spine surgery instrumentation in the U...