Likewise, cases are uploaded on a voluntary basis by state and federal judges and courts, which may lead to selection bias. 2,24,28,36. Spine 24:23522357, 1999. 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. A total of 2724 screws were placed in 127 patients. Facebook Google Plus Youtube RSS Email. were excluded from analysis. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. 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). pedicle screw misplacement malpractice. Pedicle screw instrumentation is widely used for the stabilization of the subaxial cervical, thoracic, and lumbar spine. Guzek RH, Mitchell SL, Krakow AR, Harshavardhana NS, Sarkissian EJ, Flynn JM. 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. The instrumentation and bone graft were left in place in these patients (total infection rate, 2.7%). Please do not include any confidential or sensitive information in a contact form, text message, or voicemail. 2022 Dec;31(12):3544-3550. doi: 10.1007/s00586-022-07427-0. 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, seven (6.3%) dural tears occurred during the decompression and none occurred during instrumentation. What can spine surgeons do to improve patient care and avoid medical negligence suits? As part of the surgery, Dr. Taras Masnyk inserted four metal screws into the plaintiff's spine. At the lumbosacral area, breakage of a divergent screw of a Chopin block occurred on only one side with no loss of correction. Presse Med 78:14471448, 1970. Whitecloud III TS, Butler JC, Cohen JL, Candelora PD: Complications with the variable spinal plating system. Finally, considering the problems of balance, it seems that failure to properly evaluate any preexisting scoliosis was a main cause of this important complication. 2017 Mar;5(2):109-116. doi: 10.1016/j.jspd.2016.10.007. The rate of medical complications was 8%. Jury awards $4.5M over misplaced pedicle screw during spine surgery: 5 things to know Spine Monday, May 7th, 2018 Post Listen Text Size On April 6, a Union County, N.J., jury awarded a plaintiff $4.5 million over a botched spine surgery. 10. The rod is held in place by "pedicle screws," which the surgeon must insert into the pedicles. Administrative/technical/material support: Mehta, Wang, KD Than. Importantly, these advanced technologies are not always readily available or the standard of care and cannot supplant a thorough understanding of operative anatomy, a high-quality surgical technique, and general complication-avoidance measures. Nayar G, Blizzard DJ, Wang TY, et al. Pedicle screw accuracy in thoracolumbar fractures- is routine In patients with degenerative conditions, all of the affected segments were included in the instrumentation and each vertebra was fixed with two pedicle screws. And while the jury debated for about two hours, at the end of its deliberation it sided with the defendants and entered a not guilty verdict. Defensive medicine in U.S. spine neurosurgery. Characteristics of medicolegal cases related to misplaced screws in spine surgery. We attribute the 24.1% disc space narrowing in the instrumented segments mainly to the severe injury of the disc and communication of the end plate in burst fractures, which could accelerate the disc degeneration and narrowing. Epub 2021 Aug 28. GraphPad Prism version 6.01 for Windows was used for all descriptive analyses (GraphPad Software). Whitecloud et al 35 reported an overall 45% rate of minor and major complications, with the rate of complications increasing to 63% in patients who had previous lumbar surgery. Pedicle instrumentation in the thoracolumbar and lumbar spine is a technically challenging procedure. Examples of both laterally and medially misplaced lumbar pedicle screws are provided in Fig. 2021 Nov;9(6):1541-1548. doi: 10.1007/s43390-021-00377-5. J Am Coll Surg. Moreover, several cases stated that the surgeon used only the anteroposterior or the lateral view, but not both, and the plaintiffs counsel used this information in support of their claim. 2. The link was not copied. 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. Malpractice issues in neurological surgery. Cookie Policy. Recently, robot-assisted pedicle screw implantation has been increasingly utilized at large-volume academic centers. Achieving proper lumbar lordosis, evaluating any preexisting scoliosis, and intraoperative assessment with AP radiographs could prevent balance problems. 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. Study supervision: Goodwin, Karikari, Shaffrey, Abd-El-Barr, KD Than. Another possible cause was the high lateral torques to the entire frame that occurred during tightening of the tulip screw. J Neurosurg Spine. Descriptive analysis of state and federal spine surgery malpractice litigation in the United States. There were no observed cases of screw misplacement outside the pedicle on routine AP and lateral radiographs. Mean amounts awarded SD to plaintiffs by jury trial (n = 13) versus settlement/arbitration (n = 7), adjusted for inflation as of April 2020. The most frequent primary injury listed for a lawsuit was nerve root injury, present in 81.0% (n = 17) and 74.5% (n = 35) of plaintiff- and defendant-awarded cases, respectively (p = 0.7). 2013;123(9):20992103. 12. Spine (Phila Pa 1976). Some error has occurred while processing your request. 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. Image intensification and the technique recommended by Weinstein et al 32 was used for screw placement in the lumbar vertebrae, whereas Chopin blocks (Medtronic Sofamor Danek) with two screws diverging bilaterally were used for sacral fixation. Spine 17:834837, 1992. 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. 5. 27. Accuracy and workflow of navigated spinal instrumentation with the mobile AIRO CT scanner. Among the plaintiff-awarded cases, 13 (61.9%) were decided by jury trial, 7 (33.3%) by settlement, and 1 (4.8%) by arbitration. Retrospective Computed Tomography Scan Analysis of Percutaneously However, the highest offer had been a combined $300,000 from the two defendants. Pedicle screw placement accuracy impact and comparison between grading There were two complete degenerations of the upper disc, one central canal stenosis, and two asymptomatic disc space narrowings and retrolistheses. Bydon M, Xu R, Amin AG, Macki M, Kaloostian P, Sciubba DM, Wolinsky JP, Bydon A, Gokaslan ZL, Witham TF. 2014 Aug 1;14(8):1702-8. doi: 10.1016/j.spinee.2014.03.044. Sub-analysis of adolescent idiopathic scoliotic patients showed no curve or patient characteristic that correlated with IMP or SAR. 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. Most of these complications were minor and with the exception of two misplaced screws, did not contribute to the occurrence of neurologic impairment or severe pain. Roy-Camille R, Roy-Camille M, Demeulenaere C: Osteosynthese du rachis dorsal, lombaire et lombo-sacre par plaque metalliques vissees dans les pedicules vertebraux et es apophyses articularies. Surg Neurol. 2021 Nov 26;22(1):986. doi: 10.1186/s12891-021-04860-y. Would you like email updates of new search results? (A) Anteroposterior and (B) lateral radiographs show coronal imbalance that developed 4 years after surgery in a 57-year-old woman with L3L4 float fusion. Spine 13:696706, 1988. Kreisman Law Offices has been handling Illinois surgical error lawsuits for individuals and families for more than 35 years in and around Chicago, Cook County and surrounding areas, including Batavia, Bellwood, Deerfield, Evanston, Franklin Park, and Lansing. Determining legal responsibility in otolaryngology: a review of 44 trials since 2008. leg pain. Todd NV. Litigation resulted in average payouts of $1,204,422 $753,832 between 1995 and 2019, when adjusted for inflation. 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. shooting in valdosta leaves one dead Plaintiff's expert was prepared to testify at trial that these complaints are characteristic of a malpositioned screw impinging upon a neural structure. National Library of Medicine concluded that the robot-assisted technique was significantly more accurate than the traditional freehand technique.39 Despite the learning curve and initial cost of obtaining technologies such as 3D fluoroscopic devices, intraoperative CT, or robotic navigational systems, the routine use of these technologies for intraoperative imaging confirmation and potential revision of misplaced screws may help spine surgeons avoid inadvertent iatrogenic morbidity for their patients and potential litigation. 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. The average age of the patients was 47 years and the average followup was 35 months. After the removal of duplicates, a total of 68 unique cases met our inclusion criteria and were included for analysis. The third patient, who had central spinal stenosis, was treated by decompression alone. Malpractice risk according to physician specialty. 8600 Rockville Pike Spinal fusion in the United States: analysis of trends from 1998 to 2008. Dr. Shaffrey holds patents with, receives royalties from, and is a consultant for Medtronic, NuVasive, and Zimmer Biomet; is a stockholder in NuVasive; is a consultant for K2M, Stryker, SI Bone, and In Vivo; and has received grants from the ISSG, DePuy Synthes, and AO Spine. 2014;20(2):196203. Daniels AH, Ruttiman R, Eltorai AEM, et al. Under this theory of liability, the plaintiff needed to not only establish that she had experienced foot drop, a fact that no one was disputing, but that it was caused by the defendants negligence. Hsu K, Zucherman JF, White AH: Internal Fixation With Pedicle Screws. 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. Except for two patients with spinal metastatic disease, all other patients received an iliac crest autologous bone grafts. Junctional problems were recorded as pathologic changes of the adjacent motion segments, just above and below the instrumented and fused segments. In White AH, Rothman RH, Ray CD (eds). Clinical Orthopaedics and Related Research, Get new journal Tables of Contents sent right to your email inbox, The Association of Bone and Joint Surgeons, Complications and Problems Related to Pedicle Screw Fixation of the Spine, Articles in Google Scholar by Pavlos Katonis, MD, Other articles in this journal by Pavlos Katonis, MD, Privacy Policy (Updated December 15, 2022). Spine 6:263267, 1981. may email you for journal alerts and information, but is committed Nahed BV, Babu MA, Smith TR, Heary RF. Orthop Trans 11:99, 1987. Spine 18:23252326, 1993. 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 Patient-specific 3D-printed surgical guides for pedicle screw insertion Clin Orthop 227:1023, 1988. In two patients in the current series, dislodgement of the rods from tulip screws occurred, as reported originally by Edmunds et al. Schatlo B, Molliqaj G, Cuvinciuc V, et al. Edmunds I, Cummine J, Fearnside M: Prevention of dislodgement of Cotrel-Dubousset rods from tulip screws. Clin Orthop 203:7598, 1986. Five patients had uneventful early postoperative course. Lawsuit information regarding the plaintiffs age at the time of the malpractice claim, sex, postoperative complaint, indication for index surgery, defendant surgeon specialty (neurosurgery vs orthopedics), and delayed diagnosis or treatment, as well as case location by state and case year, was obtained. 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.
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