28. Clin Orthop 203:7598, 1986. Malpractice litigation and the spine: the NHS perspective on 235 successful claims in England. Rovit RL, Simon AS, Drew J, et al. SECTION I SYMPOSIUM: Advances in Spine Surgery, Distribution of Spinal Disorders in 112 Patients, Classification of Complications in 64 patients. As part of the surgery, Dr. Taras Masnyk inserted four metal screws into the plaintiff's spine. Conclusion: Accuracy of fluoroscopically-assisted pedicle screw placement: analysis of 1,218 screws in 198 patients. Zdeblick 38 also reported an overall arthrodesis rate of 65% in patients without instrumentation, 77% in patients with semirigid fixation, and 95% in patients with a rigid constrained screw-rod system.
The medicolegal impact of misplaced pedicle and lateral mass screws on Bookshelf doi: 10.1097/BRS.0b013e31822a2e0a. The defense pointed to the lack of evidence that the screw had ever come into contact with the L5 nerve root. Rev Chir Orthop Reparatrice Appar Mot 62:151160, 1976.
Neurological Outcome and Management of Pedicle Screws Misplaced Totally It is easier to confuse a jury than convince a judge: the crisis in medical malpractice. 2012;37(1):6776. Screw misplacement. The rate of misplaced pedicle screws ranges from 1.1% to 28.8%, 10 although neurologic injury from misdirected pedicle screws has been reported to occur in 0% to 12% of patients. However, the misplacement of pedicle screws can lead to disastrous complications. Nyquist followed a medical malpractice lawsuit against Dr. Masnyk for his surgical error, alleging that the surgeon had improperly positioned the right L4 pedicel screw which had resulted in a nerve root injury and Nyquists subsequent foot drop. Copyright © 2023 Becker's Healthcare. It should be used by experienced and qualified surgeons who are aware of the pitfalls associated with its use. Amount awarded to plaintiffs by US region, adjusted for inflation as of April 2020. official website and that any information you provide is encrypted Wolters Kluwer Health
Spine 19:25842589, 1994. Spine 19(20 Suppl):2279S2296, 1994. Screws were divided into four categories: screws at risk (SAR), indeterminate misplacements (IMP), benign misplacements (BMP), accurately placed (AP). 0 attorneys agreed. Nayar G, Blizzard DJ, Wang TY, et al. However, published reports are increasingly demonstrative of the positive effect of pedicle fixation on arthrodesis and successful outcome in the treatment of patients with these disorders. Jena AB, Seabury S, Lakdawalla D, Chandra A. 39. Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. Nominal and inflation-adjusted award payouts were higher for trial verdicts than for settlement/arbitration, with a nominal average of $1,140,473 $841,683 versus $788,533 $306,186 awarded to the plaintiff, respectively (p = 0.30). Risk factor analysis showed smaller Cobb angles increased likelihood of all screws being AP. Clin Orthop 203:126134, 1986. were excluded from analysis. In four of these patients, bent screws occurred at 8 to 10 months after surgery; in three patients, broken screw necks were seen 1 year after surgery and in two patients, tulip screw plug dislodgments were observed at 4 and 6 months postoperatively, respectively. The case facts centered on a spinal surgery the 34 year-old plaintiff had undergone at Central DuPage Hospital. However, the medicolegal impact of misplaced screws on spine surgery has not been directly reported in the literature. 32. Three-dimensional printing versus freehand surgical techniques in the surgical management of adolescent idiopathic spinal deformity. Call Us Now For a Free Consultation | Toll Free: 800.583.8002 | Local: 312.346.0045, Cook County Surgeons Cut Common BIle Duct During Surgery, But Jury Finds for Defendants , Illinois Jury Finds in Favor of Doctor in Gallbladder Surgery that Led to Fatal Bowel Perforation , Debate Over Extent of Eye Damage Following Implant Lens Surgery Leads to $1 Million Verdict in, $75 Million Jury Verdict in Failure to Timely Diagnose Stroke, $18 Million Jury Verdict in Late Diagnosis of Breast Cancer, $300,000 Settlement for Excessive Use of Radiation, Chicago Medical Malpractice Lawyer Kreisman Law Offices Home, Contact Illinois Personal Injury Attorney Kreisman Law Offices. Mason A, Paulsen R, Babuska JM, et al. Ultimately, additional prospective, multiinstitutional large-volume studies are needed to validate these findings, and future studies should evaluate the long-term impact on the routine use of intraoperative imaging confirmation and/or computer- or robot-assisted navigation on the frequency and success of malpractice claims related to misplaced pedicle and lateral mass screws. In several of the studies in the spinal literature, the contention that instrumentation improves arthrodesis rates, considering that nonunion contributes to a poor outcome in spinal arthrodesis is favored. Unauthorized use of these marks is strictly prohibited. PLoS One. 2014;21(3):320328. Wiltse LL, Spencer CW: New uses and refinements of the paraspinal approach to the lumbar spine. 4). George Sapkas, MD, DSc; and Panayiotis J. Papagelopoulis, MD, DScGuest Editors. 2018;41(5):e615e620. Can Postoperative Radiographs Accurately Identify Screw Misplacements? Makhni MC, Park PJ, Jimenez J, et al. L3S1 spine arthrodesis was done in the first patient but the correction of scoliosis was not sufficient and coronal imbalance persisted after surgery, which accelerated the degeneration of the level just above the arthrodesis. Two patients had early postoperative postural headache that disappeared after removal of the misplaced screw. Spine 13:952953, 1988. This occurred on only one side and the correction achieved by the instrumentation was maintained. ABSTRACT: Pedicle screw loosening has been implicated in recurrent back pain after lumbar spinal fusion, but the degree of loosening has not been systematically quantied in patients. Thus, we are unable to comment on whether all misplaced screws, particularly when asymptomatic, should be revised in an effort to prevent litigation. 30. The highly litigious environment within healthcare has resulted in a majority of physicians practicing defensive medicine,15 often leading to burnout6,7 and an exorbitant ethical and financial burden on medical and surgical care.7,8 In 2008, medical liability accounted for $55.6 billion, representing 2.4% of the United States (US) healthcare expenditures that year,5,7,9,10 and the pervasive practice of defensive medicine may cost up to $210 billion annually in the US.5 A similar trend has been observed in Europe.11, Neurosurgery is the specialty most frequently affected by lawsuits and the fear of litigation, both in the US and abroad,12 with spine surgery at the forefront.11,1317 As a result, spine surgeons are nearly three times more likely than nonspine surgeons to practice defensive medicine, defined as the avoidance of high-risk procedures and the provision of unnecessary services and assessments beyond what is clinically necessary in an effort to avoid litagation.5 The average time to judgment in a case is approximately 5.1, 5.0, and 3.4 years for defendant verdicts, plaintiff rulings, and settlements, respectively.7,15 As a result, physicians spend an average of 11% of their careers dealing with one or more open malpractice claims.18 Neurosurgeons are especially impacted, spending an average of 27.2% of their careers in an open lawsuit.10. A Cotrel-Dubousset spinal system (Medtronic Sofamor Danek, Memphis, TN) was used in all patients and the total number of screws used was 658. Dr. Abd-El-Barr is a consultant for Spineology.
Thoracic pedicle screw placement: Free-hand technique - Bioline Rajaee SS, Bae HW, Kanim LE, Delamarter RB. 35. Accuracy of C2 pedicle screw placement using the anatomic freehand technique. However, the misplacement of pedicle screws can lead to disastrous complications. Spine 16:576579, 1991. 2019;19(7):12211231. J Neurosurg Spine. The aim of this study is to evaluate the accuracy of pedicle screw insertion in spondylitis tuberculosis kyphosis correction using a freehand technique. The average age of the patients was 47 years and the average followup was 35 months. All the incidental dural tears were repaired immediately and produced no clinical sequelae. 2002;27(22):24252430.
Pedicle screw replacement in spinal surgery - The MDU Neurosurgeons and orthopedic surgeons were named as the defendant in an equal number of cases, and the decision for the plaintiff versus the defendant was also similar between specialties. Disc space narrowing was the most common problem after instrumented arthrodesis and was observed in 27 patients (24.1%). 29. Dr. K. D. Than is a consultant for Bioventus and receives honoraria from DJO and LifeNet Health. J Neurosurg Spine. Unable to load your collection due to an error, Unable to load your delegates due to an error. The screws were needed to stabilize the spine and fix the fused vertebrae in place. J Bone Joint Surg 62A:13021307, 1980. Pitfall: Unstable injuries. The third patient, who had central spinal stenosis, was treated by decompression alone. Potential complications may include increased pain, infection, or mechanical . Phone/Fax: 30-2810-318361; E-mail: [emailprotected]. 13 Whitecloud et al 35 reported 15% neurologic complications, 5% being caused by incorrect screw placement. The standard imaging technique for pedicle screw insertion is two-dimensional images obtained from C-arm-type X-ray fluoroscopy. The amount awarded was not significantly different across US regions (p = 0.9; Fig. Whitecloud III TS, Butler JC, Cohen JL, Candelora PD: Complications with the variable spinal plating system. One of the common means of doing so is to place a screw into each of two adjacent spinal bones (vertebrae), and then a rod between them. Five patients had uneventful early postoperative course. Ahmadi SA, Sadat H, Scheufler KM, et al. Previous biomechanical and clinical studies defining junctional segment problems are lacking and consist mainly of case reports. Guzek RH, Mitchell SL, Krakow AR, Harshavardhana NS, Sarkissian EJ, Flynn JM. 2 One of the first obstacles regarding . Error in trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults, Spinal fusion in the United States: analysis of trends from 1998 to 2008, Safety and efficacy of pedicle screw placement using intraoperative computed tomography: consecutive series of 1148 pedicle screws, The accuracy of pedicle screw placement using intraoperative image guidance systems, Accuracy of pedicle screw insertion by AIRO, intraoperative CT in complex spinal deformity assessed by a new classification based on technical complexity of screw insertion, Pedicle screw placement accuracy using ultra-low radiation imaging with image enhancement versus conventional fluoroscopy in minimally invasive transforaminal lumbar interbody fusion: an internally randomized controlled trial, Use of the Airo mobile intraoperative CT system versus the O-arm for transpedicular screw fixation in the thoracic and lumbar spine: a retrospective cohort study of 263 patients, Accuracy and workflow of navigated spinal instrumentation with the mobile AIRO, Accuracy of pedicle screw placement and clinical outcomes of robot-assisted technique versus conventional freehand technique in spine surgery from nine randomized controlled trials: a meta-analysis, Safety and accuracy of robot-assisted versus fluoroscopy-guided pedicle screw insertion for degenerative diseases of the lumbar spine: a matched cohort comparison, Verdict/Settlement Search and Inclusion/Exclusion Criteria, Plaintiff Claim and Index Surgery Information, Impact of Medical Malpractice on Neurosurgeon and Orthopedic Surgeon Careers, Financial Burden of Medical Malpractice Claims Related to Misplaced Pedicle and/or Lateral Mass Screws, Frequency of Misplaced Pedicle and Lateral Mass Screws in Spine Surgery, Strategies to Improve the Accuracy of Screw Placement in Spine Surgery, Top 25 Cited Gamma Knife Surgery Articles - Trigeminal Neuralgia, Top 25 Cited Gamma Knife Surgery Articles - Volume 111, https://doi.org/10.3171/2020.8.FOCUS20600, https://www.bls.gov/data/inflation_calculator.htm, Volume 49 (2020): Issue 5 (Nov 2020): Medicolegal issues in neurosurgery, Single vs multiple misplaced screw(s), no. This retrospective study analyzes the complications and the problems developed during and after pedicle screw fixation in patients with spinal disorders and trauma. 2013;34(6):699705. 3). In the current study, no incidence of bent and broken screws or tulip screw plug dislodgement necessitated additional treatment, and all the patients achieved solid fusion despite the failure of instrumentation. Characteristics of medicolegal cases related to misplaced screws in spine surgery. 2022 Jun;8(2):234-241. doi: 10.21037/jss-22-28. West III JL, Bradford DS, Ogilvie JW: Results of spinal arthrodesis with pedicle screw-plate fixation. A p < 0.05 was considered statistically significant. In the current series, there were no cases of screw misplacement or vascular or neurologic complications caused by implant application. 4. Pedicle screw fixation is commonly used in spinal instrumentation surgeries to connect rods to vertebrae in order to correct spine alignment, stabilize vertebrae, and reach an arthrodesis. In addition, the median time to judgment is substantial, particularly for defendant verdicts, spanning over 4.5 years from the time of surgery. Pedicle screw insertions are commonly used for posterior fixation to treat various spine disorders.
True accuracy of percutaneous pedicle screw placement in thoracic and Several studies reveal that fusion rates increase when rigid internal fixation is used, 14,20,21,33,38 and that by using pedicle screws and plates or rods for stabilization, spinal arthrodesis can be limited to the disease segments. 2017;42(3):177185. However, we did not observe any screw breakage in patients with a degenerative lumbar spine, and the absence of broken screws in this series is because arthrodesis in almost all patients occurred in situ. Presse Med 78:14471448, 1970. Methods. A TLIF is a surgical procedure that attempts to fuse vertebrae in order to stabilize the patient's spine. Clin Orthop 203:4553, 1986. A total of 69 patients (mean age, 67.416 . Long spine fixation was necessary for patients with tuberculous spondylitis and metastatic disease. Additional survey data have shown that 50% of physicians exhibit at least a temporary loss of self-esteem after a malpractice claim, and at least 25% experience depression.22 As stated above, the average neurosurgeon spends 27.2% of his or her entire career in an open malpractice claim,10 and each case can take an average of 5.1, 5.0, and 3.4 years for defendant verdicts, plaintiff rulings, and settlements, respectively.7,15 Likewise, neurosurgeons have a higher risk than practitioners in other specialties of being named in multiple malpractice suits given the particularly high-risk nature of the specialty.10 Even when found in favor of the defendant (surgeon), each case ultimately takes a substantial emotional and financial toll on the physician(s) involved. leg pain. and transmitted securely. Forty-seven intraoperative and medical complications were observed in 41 patients (36.6%). (A) Anteroposterior and (B) lateral radiographs taken 2 years after surgery show unilateral pseudarthrosis in a 55-year-old man with spinal stenosis. General complications were considered those developing during and after surgery that were not directly related to instrumentation. Please do not include any confidential or sensitive information in a contact form, text message, or voicemail. 25. Comparetto, Esq., 727-328-7900, www.florida-malpractice-lawyers.com. Acta Neurochir (Wien). Accuracy and workflow of navigated spinal instrumentation with the mobile AIRO CT scanner. When adjusted for inflation, these values increased to $1,330,201 $882,023 versus $970,832 $381,619, respectively (p = 0.32; Fig. Furthermore, 25 patients (22.3%) reported persistent pain in the iliac crest (donor graft site) for several months, for which they were treated with repeated lidocaine injections and analgesics. However, 5-10% of those misplaced screws are cause for concern." "To rectify this, we must have access to imaging devices during the procedure. Don't jump in get legal help. 9.
$2 Million Spinal Surgery Case Against Neurosurgeon and Hospital Re: malpositioned pedicle screw resulting in additional surgery and disability. However, the impact of robotic-assisted spinal fusion on patient outcomes is less clear. Intraoperative pedicle fractures requiring further points of fixation. Am J Transl Res. 2014;20(2):196203. Quraishi NA, Hammett TC, Todd DB, et al.
2022 Dec;31(12):3544-3550. doi: 10.1007/s00586-022-07427-0. In situ spine arthrodesis permits load sharing by the vertebral bodies, preventing fatigue failure of the implant. 37. Neurosurgical practice liability: relative risk by procedure type. Unilateral nonunion was seen in three patients (2.7%), associated with implant failure in one of the patients. 38. Pedicle screws have been used to treat spinal disorders, including those caused by spinal cancer, congenital anomalies, trauma, and chronic pain syndromes. Surg Neurol Int. Pedicle screw fixation is an effective but demanding method to treat various spinal disorders and is associated with a significant complication rate. J Neurosurg Spine. Conception and design: Sankey, KD Than. Epstein NE. 2017;27(4):470475. Segal J. Retrospective analysis of reasons and revision strategy for failed thoracolumbar fracture surgery by posterior approach: a series of 31 cases. Zdeblick TA: A prospective randomized study of lumbar fusion: Preliminary results.
Open lumbar pedicle screw technique - Operative Neurosurgery A retrospective review of charts, XRs and low-dose CT scans of 127 patients who underwent spinal fusion with pedicle screws for spinal deformity was performed. Neurosurgery. However, the defendant doctor maintained that Nyquists foot drop was not caused by the misplaced screw. Determining legal responsibility in otolaryngology: a review of 44 trials since 2008.
Patient Suffers Permanent Nerve Damage From Spinal Surgery Nyquist had requested the defendants offer, which in retrospect was perhaps a poor decision in light of the Kane County jurys verdict. Studies have shown that the greatest proportion of malpractice claims in spine surgery are related to procedural error,10,11,14,16,17,19 often resulting in the highest payouts.11,20 For spine surgery, one common area for the potential avoidance of malpractice claims and subsequent payouts involves misplaced pedicle and/or lateral mass screws, which occurs in approximately 14%55% of cases using standard techniques and results in neurological injury and/or durotomy in approximately 1%8% of cases.21 Misplaced screws have the potential to cause severe and sometimes permanent neurological deficits, including spinal cord and/or nerve root injury,21 as well as to decrease the stability of the fusion construct, leading to delayed complications related to pseudarthrosis. J Neurosurg Spine. 1,12,19,22 The largest series of adjacent segment breakdown was reported by Schlegel et al. Notwithstanding these concessions, the MDU argued that misplacement of pedicle screw tracts was common in surgery of this kind, even in experienced and competent hands. Administrative/technical/material support: Mehta, Wang, KD Than. MeSH Pedicle instrumentation in the thoracolumbar and lumbar spine is a technically challenging procedure. 2012;21(suppl 2):S196S199. Clipboard, Search History, and several other advanced features are temporarily unavailable. Unfortunately, the plaintiffs attorney was unable to offer an alternative theory of surgical negligence that would refute the defendants explanation. It argued that the foot drop was unavoidable and due to the surgeons need to manipulate the right L5 nerve root in order to remove Nyquists herniated disc during the spinal fusion surgery. 2014;20(6):636643. Spine 6:263267, 1981. Spine 18:983991, 1993. Spine (Phila Pa 1976). However, following the spinal fusion, Nyquist began to experience foot drop in her right foot. Dr. Karikari is a consultant for NuVasive, Globus, Johnson & Johnson, and DePuy and receives a spine fellowship fund from NuVasive. 2014;96(4):266270. 3. Orthopedics. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Results: Screws penetrating the anterior cortex and abutting vascular structures, particularly aortic abutment with left-sided screws, which can lead to erosion and pseudoaneurysms. 2018;83(5):9971006. Sethi MK, Obremskey WT, Natividad H, et al. Friedlander and Bradley will pay half of the $2.25 million. Facebook Google Plus Youtube RSS Email. 144 Yuan et al 37 reported that the use of spinal instrumentation is associated with higher rate of infection (3%6%), neurologic injury (1%5%), instrumentation failure (6%10%), and reoperation (20%), compared with in situ arthrodeses. You may be trying to access this site from a secured browser on the server. Complete degeneration of the upper disc developed in two patients who had spinal stenosis and degenerative scoliosis. Spine neurosurgeons facing the judicialization of their profession: disenchantment and alteration of daily practicea qualitative study. PMC 1. The link was not copied. Quinnell RC, Stockdale HR: Some experimental observations of the influence of a single lumbar floating fusion on the remaining lumbar spine. may email you for journal alerts and information, but is committed
The physician ordered an MRI of the lumbar spine which showed that the screws had been misplaced and were puncturing the patient's lumbar nerves. Using Low-Dose, Biplanar Imaging to Reduce Screw Misplacement. Spine fixation included one segment in 27 patients, two segments in 38 patients, three segments in 42 patients, and more than three segments in five patients. NCI CPTC Antibody Characterization Program. Placement of thoracolumbar pedicle screws using three-dimensional image guidance: experience in a large patient cohort. Bydon M, Xu R, Amin AG, et al. Although the rationale for using pedicle screw fixation is fairly clear, controversy continues regarding the application of pedicle instrumentation for spine arthrodesis, especially on the degenerative lumbar spine. 2. Edmunds I, Cummine J, Fearnside M: Prevention of dislodgement of Cotrel-Dubousset rods from tulip screws. Except for the patient with an infected pseudarthrosis who had a flat back syndrome (sagittal imbalance) develop, coronal imbalance was observed in five patients (4.5%), and ranged from 7.5 to 12 (Fig 3). 14. Sub-analysis of adolescent idiopathic scoliotic patients showed no curve or patient characteristic that correlated with IMP or SAR. Intraoperative and postoperative complications were recorded by the authors and the results were evaluated by an independent observer. 2013;32(1):111119. pedicle screw misplacement malpractice.
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