The screws were needed to stabilize the spine and fix the fused vertebrae in place.
Pullout performance comparison of pedicle screws based on cement Overall reported screw misplacement is low, but it does not reflect the potential impact on patient morbidity. Spine 18:18621866, 1993. 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. Steinmann JC, Herkowitz HN: Pseudarthrosis of the spine. Problems at the junctions of the instrumented spine were seen in five patients (4.5%). Spine surgery has been disproportionately impacted by medical liability and malpractice litigation, with the majority of claims and payouts related to procedural error. Neurologic injury. These risks can be minimized by the judicious use of instrumentation by experienced surgeons for specific indications as supported by the literature. Spine 13:10121018, 1988. Ultimately, no significant differences were seen in inflation-adjusted award information between plaintiff and defendant (Table 3).
Pedicle screw replacement in spinal surgery - The MDU 8. As compared to cases in 19952009, those in 20102019 resulted in a significantly higher average nominal payout to plaintiffs ($776,439 $74,460 vs $1,506,000 $385,527, p = 0.028). Finally, considering the problems of balance, it seems that failure to properly evaluate any preexisting scoliosis was a main cause of this important complication. Achieving proper lumbar lordosis, evaluating any preexisting scoliosis, and intraoperative assessment with AP radiographs could prevent balance problems. Safety and efficacy of pedicle screw placement using intraoperative computed tomography: consecutive series of 1148 pedicle screws. Spine (Phila Pa 1976). Misplacement rates have been reported to be from 5 to 41% in the lumbar spine and from 3 to 55% in the . While reported to be one of the best legal research resources available and utilized in several previous studies,7,14,16,23,24 available court documents and clinical/operative details are highly variable and greatly limited among case files. 38. Although the rate of the reported medical complications was high (36.5%), these did not significantly affect the final clinical outcome of the current patients. It was firstly introduced by Harrington and Tullos in 1969 and then in late 1980s developed by Roy Camille et al., Louis, and Steffe. The third surgical procedure removed the pedicle screws but left the patient in an unfused state with an unstable spine. Seabury SA, Chandra A, Lakdawalla DN, Jena AB. In their meta-analysis of nine randomized controlled trials, Li et al. It is easier to confuse a jury than convince a judge: the crisis in medical malpractice. Screws penetrating the anterior cortex and abutting vascular structures, particularly aortic abutment with left-sided screws, which can lead to erosion and pseudoaneurysms. Spine 19(20 Suppl):2279S2296, 1994. Figure 1: Lower thoracic pedicles provide the firm purchase of the pedicle screw from a lateral starting point and 10-15 degrees convergent angle Surgical technique "Free Hand" pedicle screw placement [50] Our "Free Hand" technique is equivalent for lumbar and 2021 Nov 26;22(1):986. doi: 10.1186/s12891-021-04860-y. A total of 2396 screws were placed accurately (87.96%). 2014;96(4):266270. Copyright 1944-2023 American Association of Neurological Surgeons, Copy this link, or click below to email it to a friend. Med Econ. Bethesda, MD 20894, Web Policies 2018;83(5):9971006. 39. Spine arthrodesis was evaluated with plain AP and lateral radiographs taken 1 year after surgery. Accuracy of C2 pedicle screw placement using the anatomic freehand technique. Br J Neurosurg. Linking and Reprinting Policy. We serve the following localities: Cook County including Arlington Heights, Barrington, Berwyn Township, Chicago, Des Plaines, Glenview, Orland Park, Palos Park, Schaumburg, and Tinley Park; DuPage County including Downers Grove, Naperville, and Bolingbrook; Kane County including Aurora, Elgin and Geneva; Lake County including Waukegan; and Will County including Joliet. reported that 69.3% of neurosurgeons who responded to their survey saw every patient as a potential lawsuit.1. Would you like email updates of new search results? Pedicle screw insertion in the thoracolumbar spine. J Bone Joint Surg 61A:201207, 1979. Problems in the instrumented segments were considered those occurring from narrowing of the disc space greater than 3 mm, pseudarthrosis, and loss of reduction. The majority of screws were misplaced in the lumbar spine for both plaintiff- and defendant-awarded cases (66.7% vs 57.4%, respectively, p = 0.564; Table 1). After the removal of duplicates, a total of 68 unique cases met our inclusion criteria and were included for analysis. Malpractice liability and defensive medicine: a national survey of neurosurgeons. 1 To be effective, the pedicle screw constructs must withstand intraoperative loading and physiological forces due to daily postoperative activities. The average age of the patients was 47 years and the average followup was 35 months. From the *Department of Orthopaedic Surgery, University of Crete Medical School, Heraklion, Greece; and the **First Department of Orthopaedics, University of Athens Medical School, Athens, Greece. In addition, studies have shown that over 85% of malpractice claims are either dismissed or settled out of court,14 which likely results in a high degree of underreporting. Although pedicle screw fixation opened a new horizon of spinal surgery by providing rigid fixation of the spine, it is a technically demanding procedure with potential complications including medical complications, hardware and technical problems, and long-term changes of junctional motion segments. Defensive medicine: a culprit in spiking healthcare costs. Int Orthop 20:3542, 1996. Clipboard, Search History, and several other advanced features are temporarily unavailable. 2014;20(6):636643. The link was not copied. Pediatric pedicle screw placement using intraoperative computed tomography and 3-dimensional image-guided navigation. Nayar G, Blizzard DJ, Wang TY, et al. 5 Those authors recommend that particular care should be taken in inserting the washers without cross threading and ensuring that they are locked down tightly, with an adequate length of rod protruding beyond the screw. Disclosures Dr. Karikari is a consultant for NuVasive, Globus, Johnson & Johnson, and DePuy and receives a spine fellowship fund from NuVasive. However, despite the apparent widespread use of pedicle system fixation, few studies of problems and particularly complications have been published. 2021 Nov;9(6):1541-1548. doi: 10.1007/s43390-021-00377-5. Screw misplacement. This step in implant evolution was inevitable, because prior phases of implant development did not control each plane of motion segment stress. Unauthorized use of these marks is strictly prohibited. None of these complications resulted in additional surgery or in a significant increase of morbidity.
Neurological outcome and management of pedicle screws - PubMed Guillain A, Moncany AH, Hamel O, et al. A large number of studies have reported that in conventional thoracolumbar surgery, compared with traditional freehand screw placement, the accuracy of intraoperative pedicle screw placement has been improved with O-arm intraoperative navigation technology. PMC 1). Epstein NE. A Cotrel-Dubousset spinal system (Medtronic Sofamor Danek, Memphis, TN) was used in all patients and the total number of screws used was 658. J Spine Surg.
Patient-specific 3D-printed surgical guides for pedicle screw insertion Pitfall: Unstable injuries. Misplacement of Pedicle Screws Leads to Years of Pain and Opioid Addiction Nationally Recognized Regionally Dominant Contact Us Now For a Free Consultation Over $850 Million in Verdicts and Settlements Home Articles Misplacement of Pedicle Screws Leads to Years of Pain and Opioid Addiction Determining legal responsibility in otolaryngology: a review of 44 trials since 2008. In the current series, there were no cases of screw misplacement or vascular or neurologic complications caused by implant application. Clin Orthop 203:4553, 1986. 34. Pedicle screw insertions are commonly used for posterior fixation to treat various spine disorders, deformities, and trauma. Spine (Phila Pa 1976). Thu, May 27th, 2021. Accuracy and workflow of navigated spinal instrumentation with the mobile AIRO CT scanner. Spine 13:952953, 1988. In the current series, including general complications, only 48 patients (43%) had no notable complication and the remaining 64 patients (57%) had one or more complications. Acta Neurochir (Wien). J Neurosurg Spine. Please enable scripts and reload this page. Another possible cause was the high lateral torques to the entire frame that occurred during tightening of the tulip screw. (%), Pseudarthrosis requiring revision surgery. At the lumbosacral area, breakage of a divergent screw of a Chopin block occurred on only one side with no loss of correction. Adjusted for age and preoperative Cobb angle, patients with a higher misplacement rate were more likely to have screws . States were then grouped by US region and case year by 5-year intervals. The https:// ensures that you are connecting to the 19. All Rights Reserved. Patient safety: disclosure of medical errors and risk mitigation. 13 Whitecloud et al 35 reported 15% neurologic complications, 5% being caused by incorrect screw placement. Start; O firmie; Usugi; Serwis; Realizacje i porady; Kontakt Lumbar Spine Surgery. 2014 Sep;21(3):320-8. doi: 10.3171/2014.5.SPINE13567. Luque ER: Segmental spinal instrumentation of lumbar spine. 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. Spine 15:1114, 1990. 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. 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. As part of the surgery, Dr. Taras Masnyk inserted four metal screws into the plaintiff's spine. 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). 2017 Mar;5(2):109-116. doi: 10.1016/j.jspd.2016.10.007. Spine 16(8 Suppl):S422427, 1991. Of the 112 patients, 57 patients had a lumbar degenerative disorder, (lumbar degenerative spinal canal stenosis in 23 patients, degenerative or spondylolytic spondylolisthesis in 12 patients, postlaminectomy instability or stenosis in 20 patients, and recurrent disc prolapse in two patients), 42 patients had spinal cord injury, eight patients had infection, and five patients had a spinal tumor (Table 1). Spine 13:696706, 1988. Dr. Abd-El-Barr is a consultant for Spineology. 1. Agarwal N, Gupta R, Agarwal P, et al. Am J Otolaryngol. Debate Over Extent of Eye Damage Following Implant Lens Surgery Leads to $1 Million Verdict in Zaleski v Elmhurst Eye Surgery Center. Hsu K, Zucherman JF, White AH: Internal Fixation With Pedicle Screws. 2022 Dec;31(12):3544-3550. doi: 10.1007/s00586-022-07427-0. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Harrington PR, Tullos HS: Reduction of severe spondylolisthesis in children. Aigner R, Bichlmaier C, Oberkircher L, Knauf T, Knig A, Lechler P, Ruchholtz S, Frink M. BMC Musculoskelet Disord. Both issues represent the most frequent and highest payouts in spine malpractice claims.10,14,22 While several studies have explored many of the factors related to malpractice claims in spine surgery, the medicolegal impact of misplaced pedicle and/or lateral mass screws has not been directly reported in the literature. 17,18,31,39 Edwards 6 showed that solid arthrodesis developed in 96% of patients without previous surgery, whereas 84% of patients having secondary operations experienced a similar result. Elizabeth Hofheinz, M.P.H., M.Ed. Categorical and continuous data are described as frequency (percentage) and median (interquartile range), respectively, except for the use of mean standard deviation for award amounts since both nominal and inflation-adjusted award totals passed (alpha = 0.05) the DAgostino-Pearson omnibus normality test. The remaining two patients had asymptomatic junctional problems develop after two- and three-segment fusions, at the third and fourth postoperative year, respectively. Two patients with associated injuries in the lower limbs had deep venous thrombosis develop, three patients had pneumonia develop, and four patients with neurologic impairment had urinary tract infections develop. The states with the most cases included California (n = 10, 14.7%), New York (n = 6, 8.8%), Pennsylvania (n = 6, 8.8%), and Illinois (n = 5, 7.3%; Table 2). Misplaced pedicle and lateral mass screws result in a considerable risk of malpractice litigation against spine surgeons. 37. Results. Spine (Phila Pa 1976). Copyright © 2023 Becker's Healthcare. The medicolegal landscape of spine surgery: how do surgeons fare?
Complications and Problems Related to Pedicle Screw Fixation - LWW Risk factor analysis showed smaller Cobb angles increased likelihood of all screws being AP. Am J Orthop. Instead, the defense offered up an alternative explanation for Nyquists foot drop. Review of neurosurgery medical professional liability claims in the United States. The patient suffered permanent nerve damage as a result of the puncture. Lali Sekhon, Jocelyn Idema & more: 4 spine and neurosurgeons making headlines, Spinal cord stimulation trumps medication for pain reduction 7 takeaways, Dr. Khalid Kurtom on major trends in spinal cord injury surgery. This device was used with an early version of the Cotrel-Dubousset instrumentation to provide sacral fixation and it is rarely used since the more widespread use of newer spine fixation systems. Insuring spinal neurosurgery. doi: 10.1097/BPO.0000000000001828. 2016;25(3):716723. and transmitted securely. Federal government websites often end in .gov or .mil. A total of 2724 screws were placed in 127 patients. To evaluate the accuracy of pedicle screw placement using a novel classification system to determine potentially significant screw misplacement. In addition, the median time to judgment is substantial, particularly for defendant verdicts, spanning over 4.5 years from the time of surgery. Of note, while only 38.2% (n = 26) of cases in our study mentioned the use of intraoperative radiographic confirmation, only one of these cases reported that the misplaced screw had been caught prior to leaving the operating room, which had resulted in an inadvertent dural tear and L5 nerve root injury. Spine 6:263267, 1981. In addition, seven (6.3%) dural tears occurred during the decompression and none occurred during instrumentation. Epub 2014 Jun 13. Yuan HA, Garfin SR, Dickman CA, Mardjetko SM: A historical cohort study of pedicle screw fixation in thoracic, lumbar and sacral spinal fusions.
Jury Verdict for Doctor for Screw Allegedly Misplaced During Lumbar An official website of the United States government. All of these patients were asymptomatic and had satisfactory final clinical outcomes (Fig 2). Studdert DM, Mello MM, Sage WM, et al. All the operations were done by one surgeon (PK). The cost of defensive medicine on 3 hospital medicine services, Defensive medicine in neurosurgery: the Canadian experience, Review of neurosurgery medical professional liability claims in the United States, A nine-year review of medicolegal claims in neurosurgery, Malpractice risk according to physician specialty, Neurosurgical experience with malpractice litigation: an analysis of closed claims against neurosurgeons in New York State, 1999 through 2003, Descriptive analysis of state and federal spine surgery malpractice litigation in the United States, Malpractice litigation following spine surgery, Medical malpractice in orthopedic surgery: a Westlaw-based demographic analysis, Malpractice claims in spine surgery in Germany: a 5-year analysis, On average, physicians spend nearly 11 percent of their 40-year careers with an open, unresolved malpractice claim, Malpractice litigation and the spine: the NHS perspective on 235 successful claims in England, Placement of thoracolumbar pedicle screws using three-dimensional image guidance: experience in a large patient cohort, It is easier to confuse a jury than convince a judge: the crisis in medical malpractice, Determining legal responsibility in otolaryngology: a review of 44 trials since 2008, Legal liability in iatrogenic orbital injury, Spine neurosurgeons facing the judicialization of their profession: disenchantment and alteration of daily practicea qualitative study, Malpractice issues in neurological surgery. The accuracy rate of pedicle screw (PS) placement varies from 85% to 95% in the literature. 6 Several studies have shown that spine surgery is at the highest risk for litigation among the surgical subspecialties.12,29 The majority of claims are related to technical and procedural errors,29 including misplaced pedicle and/or lateral mass screws. [] Computer-assisted computed tomography (CT) techniques have improved the overall accuracy for pedicle screw placement, and has reduced complication rates. 2016;124(5):15241530. 2014;21(3):320328. 16. Cerebrospinal fluid fistulas. However, the highest offer had been a combined $300,000 from the two defendants. You are talking one of the most complicated area of the law. Rev Chir Orthop Reparatrice Appar Mot 62:151160, 1976. Eur Spine J. Operative information including fusion level, number of levels fused, level of misplaced screw(s), single versus multiple misplaced screw(s), presence of known CSF leakage, and primary injury due to screw misplacement was also collected. To investigate intraoperative reinsertion of percutaneous pedicle screw (PPS) with intraoperative CT-based navigation and to evaluate the rate of deviation of PPS at postoperative radiographic examination.
pedicle screw misplacement malpractice And while the offending screw was removed the next day, Nyquist continued to experience right foot drop, along with lower back pain and sciatica, i.e.
(PDF) Lumbosacral pedicle screw placement using a fluoroscopic pedicle Bydon M, Xu R, Amin AG, Macki M, Kaloostian P, Sciubba DM, Wolinsky JP, Bydon A, Gokaslan ZL, Witham TF. NCI CPTC Antibody Characterization Program. Guzek RH, Mitchell SL, Krakow AR, Harshavardhana NS, Sarkissian EJ, Flynn JM. McAfee PC, Weiland DJ, Carlow JJ: Survivorship analysis of pedicle spinal instrumentation. This study revealed an overall accuracy rate of 95.2% of mainly percutaneously inserted pedicle screws according to the classification of Zdichavsky et al. may email you for journal alerts and information, but is committed
sharing sensitive information, make sure youre on a federal Judgment information associated with a defendant (surgeon) versus plaintiff (patient) ruling, trial versus settlement versus arbitration decision, award amount, and time to decision or case closure from index surgery was also recorded. Epstein NE. Rajasekaran S, Bhushan M, Aiyer S, et al. This retrospective analysis of 68 closed medicolegal cases related to misplaced screws in spine surgery showed that neurosurgeons and orthopedic spine surgeons were equally named as the defendant (n = 32 and 31, respectively), and cases were most commonly due to misplaced lumbar pedicle screws (n = 41, 60.3%). Clin Orthop 115:130139, 1976. Neurosurgical experience with malpractice litigation: an analysis of closed claims against neurosurgeons in New York State, 1999 through 2003. This decision must be made on a case-by-case basis at the surgeons and patients discretion after a thorough discussion of the associated risks and benefits of revision surgery.
PDF Intraoperative biomechanics of lumbar pedicle screw loosening following One hundred twelve patients were treated using the Cotrel-Dubousset pedicle screw fixation system for degenerative disease (57 patients), trauma (42 patients), infection (eight patients), and tumor (five patients) of the lumbar or thoracolumbar spine. Grubb SA, Lipscomb HJ: Results of lumbosacral fusion for degenerative disc disease with and without instrumentation: Two- to five-year follow-up. In two patients in the current series, dislodgement of the rods from tulip screws occurred, as reported originally by Edmunds et al. Spine (Phila Pa 1976). The median time to case closure was longer for defendant-awarded cases, but this finding was not statistically significant (61.5 vs 56.3 months, p > 0.05). Spine 18:23252326, 1993. Neurosurgery. single homes for sale in lehigh valley, pa single homes for sale in lehigh valley, pa Home Realizacje i porady Bez kategorii single homes for sale in lehigh valley, pa A TLIF is a surgical procedure that attempts to fuse vertebrae in order to stabilize the patient's spine.
The pedicle screws judged as misplacement. a Medial minor perforation This was followed by pseudarthrosis requiring revision surgery, present in 14.3% (n = 3) and 14.9% (n = 7) of plaintiff- and defendant-awarded cases, respectively (p = 0.99). The intent is to provide relief from pain and nerve damage. However, 5-10% of those misplaced screws are cause for concern." "To rectify this, we must have access to imaging devices during the procedure. 28. (A) Anteroposterior and (B) lateral radiographs taken 2 years after surgery show unilateral pseudarthrosis in a 55-year-old man with spinal stenosis. 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. In situ spine arthrodesis permits load sharing by the vertebral bodies, preventing fatigue failure of the implant. Five patients had uneventful early postoperative course. 14. 2005;293(21):26092617. This site needs JavaScript to work properly. The jury found the defendants liable and allocated 75 percent of the fault to Dr. Friedlander and 25 percent to Dr. Bradley. Incidence and costs of defensive medicine among orthopedic surgeons in the United States: a national survey study.
2,24,28,36. Drs. 2 One of the first obstacles regarding . 21. Under the high-low agreement, Drs. 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. Erwin WD, Dickson JH, Harrington PR: Clinical review of patients with broken Harrington rods. 2020;162(6):13791387. 2022 Sep 15;14(9):6323-6331. eCollection 2022. Mohar J, Vali M, Podovovnik E, Mihali R. Eur Spine J.
Jury awards $4.5M over misplaced pedicle screw during spine surgery: 5