Study DesignRetrospective legal case review.ObjectiveThe aim of this study is to assess recent trends and risk factors for litigation against U.S. spine surgeons to better understand the current medico-legal landscape and inform future care in spine surgery.MethodsThe LexisNexis legal database was queried for case summaries from January 1, 2020, to October 6, 2024, yielding 432 results. Recent medical malpractice reports involving alleged spine surgeon error causing patient injury were included.ResultsThirty-three cases met inclusion criteria. Most occurred in the South (52%) and Midwest (27%) U.S. All defendants were male spine surgeons (52% orthopedic, 48% neurosurgeons). Plaintiffs were 55% male. Most defendants were in private practice (66%); 30% worked in hospital systems. Surgeries occurred in hospitals in 61% of cases. Pain was the most common alleged surgical indication (42%), with lumbar fusions being the most frequent procedure (61%, lumbar 42%). Alleged injuries included persistent pain or radiculopathy (52%) and paraplegia (24%). The most-cited surgeon errors were failure to inform/obtain consent (21%) and cord damage (18%). Verdicts favored plaintiffs in 55% of cases. No variables were significantly associated with case outcomes ( > 0.05). When plaintiffs prevailed, the median payout was $1.62 million USD (IQR $600,000-$4.5 million USD).ConclusionsThese findings offer a limited snapshot of malpractice litigation themes in U.S. spine surgery, highlighting persistent issues with informed consent and communication. While not necessarily representative of all malpractice claims, these results may offer useful insights into potential areas for clinical and legal risk mitigation.