Rajaee SS, Bae HW, Kanim LE, Delamarter RB. Pedicle screws have been used to treat spinal disorders, including those caused by spinal cancer, congenital anomalies, trauma, and chronic pain syndromes. 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. The average age of the patients was 47 years and the average followup was 35 months. Malpractice claims in spine surgery in Germany: a 5-year analysis. Fishers exact test and the Mann-Whitney U-test were used for the analysis of categorical and continuous data, respectively, except when an unpaired t-test was utilized for analyses related to normalized, nominal, and inflation-adjusted award totals. 1. Zdeblick TA: A prospective randomized study of lumbar fusion: Preliminary results. A CT scan was taken to try and identify the underlying neurological problem that might be causing the new symptom. J Neurosurg Spine. Spine 15:908912, 1990. Pullout performance comparison of pedicle screws based on cement Thankfully, most screws are just misplaced by a millimeter or two out the front or are slightly off medially, so they are not doing real damage. Crawford MJ, Esses SI: Indications for pedicle fixation: Results of NASS/SRS faculty questionnaire: North American Spine Society and Scoliosis Research Society. Many technological advances have been made over the past several decades in an effort to improve the accuracy of screw placement in spine surgery.3436 For example, 3D fluoroscopybased image guidance has been shown to decrease the pedicle breach rate in several studies compared to the rate with 2D fluoroscopic guidance or the freehand technique, particularly in deformity and revision surgeries.21,34,36,37 CT guidance or intraoperative confirmation has also been shown to further improve the accuracy of pedicle screw placement,3638 with reported accuracy rates of 89%100% reported in the literature, depending on the authors breach criteria.35 However, it is important to note that the use of this technology is often accompanied by a lower threshold for intraoperative screw revision, sometimes leading to higher rates of replaced screws.33 Arguably, these improved trajectories may avoid iatrogenic neurological deficits due to prolonged nerve root compression or even improve the stability of the construct;34,37 however, prospective studies of long-term outcomes and rates of revision surgery remain sparse in the literature. Level of evidence: 2013;32(1):111119. Some error has occurred while processing your request. Spine neurosurgeons facing the judicialization of their profession: disenchantment and alteration of daily practicea qualitative study. Clin Orthop 227:1023, 1988. Whitecloud III TS, Butler JC, Cohen JL, Candelora PD: Complications with the variable spinal plating system. 2018;27(9):23392347. Summary of background data: Sarwahi V, Ayan S, Amaral T, Wendolowski S, Gecelter R, Lo Y, Thornhill B. Spine Deform. Comparetto, Esq., 727-328-7900, www.florida-malpractice-lawyers.com. Rather, the defense demonstrated that although the misplaced screw had in fact irritated the L4 nerve root for the six days before it was removed, the related symptoms resolved with the screws removal. One of the patients had a late wound infection develop that was treated by radical debridement and removal of instrumentation. 3. Wolters Kluwer Health Accuracy of fluoroscopically-assisted pedicle screw placement: analysis of 1,218 screws in 198 patients. shooting in valdosta leaves one dead While the majority of claims are found to lack merit, resulting in a verdict in favor of the defendant or case dismissal,7,1316 at least 37% are considered valid.26 Regardless, payouts to plaintiffs are often substantial, averaging in the hundreds of thousands to millions of dollars in both the US and Europe.10,11,14,17,20 Communication of errors and expectations, thorough documentation, and selection of appropriate patients and surgical indications have been shown to reduce the likelihood of a successful malpractice claim.13,16,27,28 In addition, attempts at tort reform in some states have helped limit the financial burden of medical malpractice payouts through methods such as capitation.16,20,22,26 However, efforts to limit malpractice claims in the first place are greatly needed. The contact form sends information by non-encrypted email, which is not secure. In the current series, there were no cases of screw misplacement or vascular or neurologic complications caused by implant application. Achieving proper lumbar lordosis, evaluating any preexisting scoliosis, and intraoperative assessment with AP radiographs could prevent balance problems. Epstein NE. The medicolegal landscape of spine surgery: how do surgeons fare? The suit claimed Dr. Friedlander failed to diagnose and treat the mispositioned screw in a timely manner, leading the plaintiff to develop pain in his right leg, numbness in his right calf and weakness in his right toes. Would you like email updates of new search results? Adjusted for age and preoperative Cobb angle, patients with a higher misplacement rate were more likely to have screws . Rynecki ND, Coban D, Gantz O, et al. Smith TR, Hulou MM, Yan SC, et al. J Bone Joint Surg 61A:201207, 1979. Critically revising the article: all authors. Rev Chir Orthop Reparatrice Appar Mot 62:151160, 1976. Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina; and, Malpractice liability and defensive medicine: a national survey of neurosurgeons, Defensive medicine among high-risk specialist physicians in a volatile malpractice environment, Defensive medicine: a culprit in spiking healthcare costs, Incidence and costs of defensive medicine among orthopedic surgeons in the United States: a national survey study, Defensive medicine in U.S. spine neurosurgery, Personal consequences of malpractice lawsuits on American surgeons. Dr. Karikari is a consultant for NuVasive, Globus, Johnson & Johnson, and DePuy and receives a spine fellowship fund from NuVasive. 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. Pedicle screw fixation is an effective but demanding method to treat various spinal disorders and is associated with a significant complication rate. Clipboard, Search History, and several other advanced features are temporarily unavailable. There were no observed cases of screw misplacement outside the pedicle on routine AP and lateral radiographs. The patient suffered permanent nerve damage as a result of the puncture. Please enable scripts and reload this page. 4). CT-navigation versus fluoroscopy-guided placement of pedicle screws at . Several limitations should be carefully considered when interpreting our results. 2013;123(9):20992103. The last two patients had a T12L1 fracture-dislocation and a L4L5 spondylolytic spondylolisthesis at the site of plug dislodgments. Pedicle screw construct have become one of the most practiced procedure in spinal surgery. 2020;11:38. Two-dimensional (2D) fluoroscopy-guided percutaneous pedicle screw (PPS) placement is currently the most widely applied instrumentation for minimally invasive treatment of spinal injuries requiring stabilization. The plaintiff received $2.4 million for pain and suffering and loss of enjoyment of life, $2 million for lost income and approximately $123,000 for medical expenses. 8,24,25,32. reporting that the number of Medicare patients who underwent a complex lumbar spine fusion for spinal stenosis increased 15-fold, from 1.3 persons per 100,000 Medicare persons in 2002 to 19.9 in 2007.31 Similarly, a study by Rajaee et al. * Daniels AH, Ruttiman R, Eltorai AEM, et al. Harrington and Tullos 11 first reported the technique of transpedicle screw fixation, and Roy-Camille et al 23 popularized the first practical method of pedicle screw fixation. Ultimately, no significant differences in case demographics were found between plaintiff and defendant judgments (Table 1). The medical malpractice suit Ayala v. Friedlander, M.D., claimed that a March 2011 lumbar fusion surgery performed by neurosurgeon Marvin Friedlander, MD, and orthopedic spine surgeon Douglas Bradley, MD, strayed from the accepted standards of care because a pedicle screw was placed in the wrong location. These risks can be minimized by the judicious use of instrumentation by experienced surgeons for specific indications as supported by the literature. A retrospective review of charts, x-rays (XRs) and computed tomography (CT) scans was performed. Amount awarded to plaintiffs by US region, adjusted for inflation as of April 2020. Medical malpractice in orthopedic surgery: a Westlaw-based demographic analysis. 144 Please do not include any confidential or sensitive information in a contact form, text message, or voicemail. [] The accuracy for free-hand screw placement technique varies from 69% to 94%. J Bone Joint Surg 54A:11951204, 1972. 2012 Feb 1;37(3):E188-94. Routine CT scans were taken in all patients. Incidence and costs of defensive medicine among orthopedic surgeons in the United States: a national survey study. Risk factor analysis showed smaller Cobb angles increased likelihood of all screws being AP. Another possible cause was the high lateral torques to the entire frame that occurred during tightening of the tulip screw. Guzek RH, Mitchell SL, Krakow AR, Harshavardhana NS, Sarkissian EJ, Flynn JM. Nayar G, Blizzard DJ, Wang TY, et al. In this example, the surgeon replaced the misplaced screw prior to leaving the operating room, which arguably played a significant role in the jury ruling in favor of the defendant (surgeon). The total number of reoperations for MPS and patient clinical data were obtained from medical records at each hospital. Objective: 2017;31(3):287288. Neurosurgery. 1. and 17.1% of the patients included had at least one screw misplaced. Rovit RL, Simon AS, Drew J, et al. 5. Intraoperative and postoperative complications were recorded by the authors and the results were evaluated by an independent observer. It is an effective procedure in that it provides an almost immediate stabilization of the spine [ 2-5 ]. Eur Spine J. 2018;18(2):209215. Spine 17:834837, 1992. 26. Error in trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. True accuracy of percutaneous pedicle screw placement in thoracic and Accuracy and workflow of navigated spinal instrumentation with the mobile AIRO CT scanner. EOS System Courtesy of EOS imaging. Pedicle screw replacement in spinal surgery - The MDU 2017;42(3):177185. What can spine surgeons do to improve patient care and avoid medical negligence suits? 2002;27(22):24252430. 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. A review of medicolegal malpractice suits involving cervical spine: what can we learn or change? Svider PF, Kovalerchik O, Mauro AC, et al. The cost of defensive medicine on 3 hospital medicine services. 1 Although this technique has advantages over open instrumentation, it also presents new challenges and specific complications. Am J Transl Res. Pedicle screw | definition of pedicle screw by Medical dictionary A retrospective review of closed medicolegal cases with verdicts or settlements between 1995 and 2019 was performed using the Westlaw Edge legal research database (Thomson Reuters).7,14,16,23,24 A search of closed federal and state malpractice claims within the Verdicts and Settlements section consisted of the following: spine and surgery and pedicle and screw and fusion and (misplaced or misguided or mispositioned) and surgeon. Inclusion criteria consisted of malpractice claims against surgeons for complications related to misplaced pedicle and/or lateral mass screws. 2. 24. While the majority of verdicts are found in favor of the defendant (surgeon), over 30% of cases in this study were found in favor of the plaintiff (patient), resulting in average inflation-adjusted payouts of over $1.2 million per claim over the past 25 years. Results: 10. were excluded from analysis. George Sapkas, MD, DSc; and Panayiotis J. Papagelopoulis, MD, DScGuest Editors. Retrospective analysis of reasons and revision strategy for failed thoracolumbar fracture surgery by posterior approach: a series of 31 cases. Spine 13:10121018, 1988. Spine 18:23252326, 1993. In the Kane County medical malpractice lawsuit of Melissa Nyquist v. Dr. Taras Masnyk and DuPage Neurosurgery, S.C., 06 L 421, the plaintiffs attorney was unable to convince the jury that the plaintiffs medical complications were caused by the defendants negligence. Spine arthrodesis was evaluated with plain AP and lateral radiographs taken 1 year after surgery. Submitting a contact form, sending a text message, making a phone call, or leaving a voicemail does not create an attorney-client relationship. 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%). Cookie Policy. Once the spine is exposed, the appropriate levels of fixation are confirmed with the image intensifier. JAMA Intern Med. Plaintiff's expert was prepared to testify at trial that these complaints are characteristic of a malpositioned screw impinging upon a neural structure. Start; O firmie; Usugi; Serwis; Realizacje i porady; Kontakt J Spine Surg. All the operations were done by one surgeon (PK). Pedicle screw insertion techniques: an update and review of the However, this difference was no longer significant when adjusted for inflation ($1,016,000 $90,875 vs $1,630,000 $422,405, p = 0.09). 3. (%), Pseudarthrosis requiring revision surgery. Neurosurgical experience with malpractice litigation: an analysis of closed claims against neurosurgeons in New York State, 1999 through 2003. This step in implant evolution was inevitable, because prior phases of implant development did not control each plane of motion segment stress. 13 Whitecloud et al 35 reported 15% neurologic complications, 5% being caused by incorrect screw placement. Spine J. Katonis PG, Kontakis GM, Loupasis GA, et al: Treatment of unstable thoracolumbar and lumbar spine injuries using Cotrel-Dubousset instrumentation. Administrative/technical/material support: Mehta, Wang, KD Than. Accuracy of C2 pedicle screw placement using the anatomic freehand 1 To be effective, the pedicle screw constructs must withstand intraoperative loading and physiological forces due to daily postoperative activities. Defendant-awarded cases by US region (right). 2014;20(6):636643. Orthop Trans 11:99, 1987. Two patients had an acute infection develop for which they required operative intervention with irrigation and debridement. 1,12,19,22 The largest series of adjacent segment breakdown was reported by Schlegel et al. 2016;25(3):716723. The remaining eight patients, including two patients with spinal trauma, five patients with infection, and one patient with a tumor, had anterior and posterior procedures. Epstein NE. 35. Complications and Problems Related to Pedicle Screw Fixation - LWW Eur Spine J. 16,24,28 Simultaneously, the evolution of the surgical techniques has led to increased procedural safety. A high-low agreement is a settlement in which a defendant agrees to pay the plaintiff a minimum recovery in exchange for the plaintiff agreeing to accept a maximum amount regardless of the trial's outcome. 2021 Nov;9(6):1541-1548. doi: 10.1007/s43390-021-00377-5. Privacy Policy. The screws were needed to stabilize the spine and fix the fused vertebrae in place. Malpractice risk according to physician specialty. 11. J Neurosurg Spine. Ann R Coll Surg Engl. Spine surgery has been disproportionately impacted by medical liability and malpractice litigation, with the majority of claims and payouts related to procedural error. 2011;365(7):629636. On April 6, a Union County, N.J., jury awarded a plaintiff $4.5 million over a botched spine surgery. Defensive medicine in neurosurgery: the Canadian experience. 2. N Engl J Med. Preparation. In the current study, only five patients with junction problems above the instrumented area were observed with the following probable predisposing factors: an already degenerative disc, coronal imbalance, very long arthrodesis, and old age. Surg Neurol Int. 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. 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. your express consent.
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