Litigation Prevention, Mediation and Alternative Dispute Resolution in Health Care: A Narrative Review of Perspectives from Orthopaedics and Spine Practice

BACKGROUND: Healthcare litigation is increasing globally and imposes significant emotional, financial and reputation and trust-related costs. Orthopaedic and spine surgery carry particularly high medico-legal risk because of technical complexity, uncertain outcomes and heightened patient expectations. Alternative dispute resolution (ADR), especially mediation, offers confidential and collaborative means to both prevent and resolve conflict. OBJECTIVES: To (i) examine litigation-prevention strategies and ADR modalities applicable to orthopaedic and spine practice; (ii) synthesise common sources of conflict, the advantages of ADR over litigation and implementation challenges within the Nigerian health system and (iii) propose recommendations for hospital governance, professional regulation and incorporation of ADR training in medical education. METHODOLOGY: A narrative review of English-language literature was conducted across biomedical databases and grey sources using predefined keywords ADR, ADR processes with outcome and barriers in low- and middle-income countries, and patient safety. Eligible studies included empirical research and programme reports. Thematic synthesis focused on conflict drivers, mediation, on medical litigation, orthopaedics, policy and legal analyses, preventive mechanisms and spine surgery. RESULTS: One hundred and fifty-two sources met the inclusion criteria. Major conflict drivers were consent and communication failures, poor documentation, expectation-outcome mismatch, disputes over surgical indication, peri-operative complications, implant and device issues, financial hardship and delayed presentation. ADR consistently showed advantages in cost, timeliness, confidentiality, therapeutic relationship preservation and learning potential. Barriers included weak institutional ADR frameworks, limited mediator clinical literacy, fragmented regulation, low insurance penetration and poor quality-improvement data. CONCLUSIONS: ADR provides an effective, confidential approach to reducing litigation in orthopaedic and spine practice by addressing communication failures early and preserving therapeutic relationships. Strengthening consent, documentation, institutional ADR pathways and mediator clinical skills, supported by policy reforms and ADR education, can reduce preventable conflicts and promote safer, more accountable surgical care in Nigeria.