Exploring the Legal Landscape of Intradural Spine Procedures: A Retrospective Analysis of US Malpractice Claims

INTRODUCTION: Intradural spine procedures carry substantial neurological risk and technical complexity, yet their associated medicolegal landscape remains poorly characterized. Improved understanding of their litigation patterns may help inform patient counseling, perioperative communication, and risk-reduction strategies. METHODS: A retrospective analysis was conducted of malpractice litigation involving common intradural spine procedures: myelomeningocele repair, tethered cord release, and intradural mass resection, using the Westlaw legal database. Inclusion required that one of the specified procedures was central to the litigation and had been performed. Data were extracted on plaintiff demographics, allegations, and outcomes. RESULTS: From an initial review of 417 cases, 22 met the inclusion criteria. Most cases (63.6%) occurred after 2005. The estimated annual litigation frequency was 1 per 1200 intradural mass resection procedures, 1 per 2950 tethered cord release procedures, and 1 per 4600 myelomeningocele repairs. Common allegations included improper informed consent (63.6%) and procedural error (50.0%). Physicians were named in 86.4% of cases, followed by hospitals or clinics (72.7%) and government entities (27.3%). At the time of review, only 4.5% had resulted in a plaintiff verdict. The mean time from surgery to legal resolution was 70.2 months. CONCLUSION: Intradural spine litigation represents an underexplored area of medical malpractice. Informed consent and procedural error were most frequently cited, highlighting the potential benefit of improved preoperative communication and surgical protocols. Intradural mass resection had the highest estimated annual frequency and involved only adult plaintiffs, reflecting possible differences between adult and pediatric populations, such as differences in baseline functional status and the role of guardians in pediatric claims.