BACKGROUND. From 1995 the cost of litigation to the National Health Service (NHS) from surgical procedures has been over 1.3 billion GBP. Spinal patients can present diagnostic challenges and the consequences of delayed diagnosis and surgical complications can be devastating. As a consequence these patients represent a high risk when surgeons seek to indemnify themselves. We therefore, aim to highlight the litigation patterns for these injuries within the United Kingdom. METHOD. Data was obtained from the NHS Litigation Authority from 2002 to 2010 which was analysed. RESULTS. Of the 236 claims, 144 were related to trauma or acute diagnostic issues and 92 from elective surgery. The total financial burden to the NHS came to 60.5 million GBP/72.5 million Euros. Of this sum 42.8 million GBP/51.3 million Euros were paid in damages, and the remaining 29% in legal costs. The financial costs were on average similar for trauma and elective cases. The most frequent cause of successful litigation for trauma were, missed fractures (41.7%), missed cauda equina (23.6%) and spinal infection (11.8%). The emergency department (43.8%), orthopaedic surgery (28.5%) and Medicine (13.9) bore the brunt of the claims. For elective surgery, Spinal Damage(19.8%), failure in Post-Operative Care (15.4%), Infection (11%) and Wrong Level Surgery, Cauda Equina and Surgical Failure at 9.9%. were likely to result in a successful claim, and the litigation burden was felt by the orthopaedic(60.4%), Neurosurgery(18.7%) and other surgical disciplines (11%). CONCLUSION. Acute spinal fractures, cord compression and infection should be considered in patients in the emergency department setting, with appropriate examination and investigations for uncertainty. A lack of awareness of at risk cases increases the likelihood of a pay-out and sums involved. For elective spinal surgery, a failure in the consenting process and the technical skill of the surgeon are likely to result in a pay-out. A failure to identify post-operative complications such as infection and thromboembolism are also indefensible. Protecting patients intra-operatively and maintaining high technical expertise and vigilance post-operative in an adequately consented patient may decrease litigation rates