pedicle screw misplacement malpractice

2005;293(21):26092617. Start; O firmie; Usugi; Serwis; Realizacje i porady; Kontakt Hecht N, Kamphuis M, Czabanka M, et al. 2021 Nov 26;22(1):986. doi: 10.1186/s12891-021-04860-y. JAMA. Malpractice liability and defensive medicine: a national survey of neurosurgeons. 2016;124(5):15241530. Epstein NE. pedicle screws sagittal alignment spinal fusion surgical guides Spinal fusion is used to treat a range of conditions associated with spinal column such as intervertebral disc degeneration and scoliosis [ 1 ]. 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). Dr. Friedlander did not order a CT or MRI until January 2013, when the pedicle screw was found to be in the wrong location and a failed fusion was diagnosed, according to the suit. 2018;27(9):23392347. Using chi square analysis, statistically significant correlation was seen between disc space narrowing and loss of postoperative correction (p < 0.01). PLoS One. When adjusted for inflation, these values increased to $1,330,201 $882,023 versus $970,832 $381,619, respectively (p = 0.32; Fig. 2017;27(4):470475. Federal government websites often end in .gov or .mil. The rate of medical complications was 8%. 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). Fortunately, most of the complications were minor and transient. Please enable it to take advantage of the complete set of features! Objective: 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. Using Low-Dose, Biplanar Imaging to Reduce Screw Misplacement. Screws penetrating the anterior cortex and abutting vascular structures, particularly aortic abutment with left-sided screws, which can lead to erosion and pseudoaneurysms. Unauthorized use of these marks is strictly prohibited. We avoid using sharp automated drilling, and probe fully the pedicle cavity to prevent nerve root impairment. 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. Ann R Coll Surg Engl. J Bone Joint Surg 61A:201207, 1979. 20. Methods: $ = US$; MW = Midwest; NE = Northeast; SE = Southeast; SW = Southwest; W = West. 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. J Neurosurg. Sarwahi V, Ayan S, Amaral T, Wendolowski S, Gecelter R, Lo Y, Thornhill B. Spine Deform. Screw misplacement. Axial lumbar CT scans demonstrating both laterally (right) and medially (left) misplaced pedicle screws, resulting in pedicle and transverse process fractures (A) and canal compromise (A and B). Johnston II CE, Ashman RB, Baird AM, Allard RN: Effect of spinal construct stiffness on early fusion mass incorporation: Experimental study. Screws were divided into four categories: screws at risk (SAR), indeterminate misplacements (IMP), benign misplacements (BMP), accurately placed (AP). The majority of plaintiffs were male (n = 44, 64.7%), and the median age among all cases was 46 years (range 3757 years). They both had motor deficits from which 1 patient recovered completely. 2012 Feb 1;37(3):E188-94. St Louis, CV Mosby 322327, 1987. However, the medicolegal impact of misplaced screws on spine surgery has not been directly reported in the literature. Mohar J, Vali M, Podovovnik E, Mihali R. Eur Spine J. Cotrel Y, Dubousset J, Guillaumat M: New universal instrumentation in spinal surgery. 8,24,25,32. Sethi MK, Obremskey WT, Natividad H, et al. Clin Orthop 115:130139, 1976. 4. Quinnell RC, Stockdale HR: Some experimental observations of the influence of a single lumbar floating fusion on the remaining lumbar spine. In White AH, Rothman RH, Ray CD (eds). 29. Ann Thorac Surg. Aigner R, Bichlmaier C, Oberkircher L, Knauf T, Knig A, Lechler P, Ruchholtz S, Frink M. BMC Musculoskelet Disord. Steinmann JC, Herkowitz HN: Pseudarthrosis of the spine. These complications may have resulted from powerful bending movement acting on the screw at its entry point to the bone. HHS Vulnerability Disclosure, Help 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. Junctional problems were recorded as pathologic changes of the adjacent motion segments, just above and below the instrumented and fused segments. This study has shown that percutaneous insertion of pedicle screws in the lumbar spine is a safe and reliable technique, and despite the low misplacement rate of only 6.6%, it should be kept in mind that the surgical procedure is technically demanding and should be performed only by experienced spine surgeons. Rothberg MB, Class J, Bishop TF, et al. Pedicle screw placement is a common procedure. 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. Spine 16(8 Suppl):S455458, 1991. Results: 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. One hundred four of the 112 patients had a posterior procedure. The patient had to undergo a subsequent surgery to remove the pedicles. Retrospective analysis of reasons and revision strategy for failed thoracolumbar fracture surgery by posterior approach: a series of 31 cases. Zucherman J, Hsu K, Picetti III G, et al: Clinical efficacy of spinal instrumentation in lumbar degenerative disc disease. 2012;89(10):7071. 2020;11:38. I won't be at the office but I will check my voice mail. Spine neurosurgeons facing the judicialization of their profession: disenchantment and alteration of daily practicea qualitative study. The incidence of screw failure, which can occur despite solid arthrodesis, 7 in the current series was 8% and mainly involved patients with thoracolumbar injury. Misplacement rates have been reported to be from 5 to 41% in the lumbar spine and from 3 to 55% in the . Of note, the award amount for one settlement case was undisclosed. Disclaimer. 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. Study supervision: Goodwin, Karikari, Shaffrey, Abd-El-Barr, KD Than. States were then grouped by US region and case year by 5-year intervals. Please try again soon. However, following the spinal fusion, Nyquist began to experience foot drop in her right foot. All these problems were observed only just above the upper instrumentation level and all were observed in patients older than 55 years. 8. 3,4,9,29,34 In addition, developments in surgical technique and implant design have decreased operative risk and implant-related complications. In 2 patients, misplacement of pedicle screws was recognized intraoperatively and all implants were removed. Facebook Google Plus Youtube RSS Email. Several limitations should be carefully considered when interpreting our results. Defensive medicine: a culprit in spiking healthcare costs. 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). J Neurosurg Spine. Spine (Phila Pa 1976). Epstein NE. Clin Orthop 284:8090, 1992. 2 One of the first obstacles regarding . All Rights Reserved. 2022 Sep 15;14(9):6323-6331. eCollection 2022. Neurosurgery. Edmunds I, Cummine J, Fearnside M: Prevention of dislodgement of Cotrel-Dubousset rods from tulip screws. This study revealed an overall accuracy rate of 95.2% of mainly percutaneously inserted pedicle screws according to the classification of Zdichavsky et al. Malpractice risk according to physician specialty. The last two patients had a T12L1 fracture-dislocation and a L4L5 spondylolytic spondylolisthesis at the site of plug dislodgments. 2013;34(6):699705. Neurosurgical practice liability: relative risk by procedure type. All Rights Reserved. This step in implant evolution was inevitable, because prior phases of implant development did not control each plane of motion segment stress. Accuracy of C2 pedicle screw placement using the anatomic freehand technique. The patient suffered permanent nerve damage as a result of the puncture. leg pain. All of these patients were asymptomatic and had satisfactory final clinical outcomes (Fig 2). West III JL, Bradford DS, Ogilvie JW: Complications of the variable screw pedicle screw fixation. Br J Neurosurg. Neurologic injury. to maintaining your privacy and will not share your personal information without Clin Orthop 203:717, 1986. The accuracy rate of pedicle screw (PS) placement varies from 85% to 95% in the literature. 24. Li HM, Zhang RJ, Shen CL. Spine 18:11601172, 1993. Mason A, Paulsen R, Babuska JM, et al. 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. Don't jump in get legal help. Lumbar Spine Surgery. Neurosurgical experience with malpractice litigation: an analysis of closed claims against neurosurgeons in New York State, 1999 through 2003. Likewise, research shows that breaches still occur when these tools are used,33,40 and some studies did not find a difference in pedicle breach rates compared to those with traditional fluoroscopic and freehand techniques.33 Ultimately, misplaced instrumentation is a risk of any spinal fusion surgery, and a thorough discussion of these risks, as well as the alternative management options, is essential to maintain high-quality patient care and to avoid litigation. 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. West III JL, Bradford DS, Ogilvie JW: Results of spinal arthrodesis with pedicle screw-plate fixation. Characteristics of medicolegal cases related to misplaced screws in spine surgery. 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%). 4). 2012;7(6):e39237. Submitting a contact form, sending a text message, making a phone call, or leaving a voicemail does not create an attorney-client relationship. Koktekir E, Ceylan D, Tatarli N, Karabagli H, Recber F, Akdemir G. Spine J. 34. Spine 18:983991, 1993. 5-7 Materials and Methods This is a retrospective study of kyphotic spondylitis tuberculosis (Stb) patients conducted at Fatmawati General Hospital, Jakarta, Indonesia, through the year 2020-2021. Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. A total of 2396 screws were placed accurately (87.96%). Arthrodesis was questionable in eight asymptomatic patients (7.1%). The https:// ensures that you are connecting to the Malpractice claims in spine surgery in Germany: a 5-year analysis. sharing sensitive information, make sure youre on a federal 5. (A) Anteroposterior and (B) lateral radiographs taken 2 years after surgery show unilateral pseudarthrosis in a 55-year-old man with spinal stenosis. J Neurosurg Spine. 2018;28(2):186193. Would you like email updates of new search results? Similarly, the highest inflation-adjusted amount awarded ($2,302,472) for pseudarthrosis was attributed to a medially breached pedicle screw during an L5S1 fusion that was determined to have caused the failed union and subsequent need for revision surgery. J Am Coll Surg. A CT scan was taken to try and identify the underlying neurological problem that might be causing the new symptom. 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. Larson AN, Santos ER, Polly DW Jr, Ledonio CG, Sembrano JN, Mielke CH, Guidera KJ. 3. Eur Spine J. J Neurosurg Spine. The .gov means its official. 1. 33. Finally, considering the problems of balance, it seems that failure to properly evaluate any preexisting scoliosis was a main cause of this important complication. Level of evidence: 2022 Dec;31(12):3544-3550. doi: 10.1007/s00586-022-07427-0. It is easier to confuse a jury than convince a judge: the crisis in medical malpractice. Except for two patients with spinal metastatic disease, all other patients received an iliac crest autologous bone grafts. 2018;18(2):209215. NCI CPTC Antibody Characterization Program. Can Postoperative Radiographs Accurately Identify Screw Misplacements? 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. 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. 32. A total of 2724 screws were placed in 127 patients. 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. Guillain A, Moncany AH, Hamel O, et al. 30. Your message has been successfully sent to your colleague. 2016;25(3):716723. Spine 13:696706, 1988. Harris RI, Wiley JJ: Acquired spondylolysis as a sequel to spine fusion. Roy-Camille R, Saillant G, Mazel C: Internal fixation of the lumbar spine with pedicle screw plating. 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 Crawford MJ, Esses SI: Indications for pedicle fixation: Results of NASS/SRS faculty questionnaire: North American Spine Society and Scoliosis Research Society. Safety and accuracy of robot-assisted versus fluoroscopy-guided pedicle screw insertion for degenerative diseases of the lumbar spine: a matched cohort comparison. 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. Amount awarded to plaintiffs by US region, adjusted for inflation as of April 2020. Stauffer RN, Coventry MB: Posterolateral lumbar-spine fusion: Analysis of the Mayo clinic series. 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 development of the transpedicle screw has provided control of the vertebral motion segment in each plane, resisting any type of load. Spine 18:23252326, 1993. Spine 13:10121018, 1988. your express consent. South Med J 62:17, 1969. MeSH In addition, seven (6.3%) dural tears occurred during the decompression and none occurred during instrumentation. It should be used by experienced and qualified surgeons who are familiar with the pitfalls associated with its use. There were no observed cases of screw misplacement outside the pedicle on routine AP and lateral radiographs. Steffee AD, Brantigan JW: The variable screw placement spinal fixation system: Report of a prospective study of 250 patients enrolled in Food and Drug Administration clinical trials. 7. 11. One of the patients had a late wound infection develop that was treated by radical debridement and removal of instrumentation. However, the misplacement of pedicle screws can lead to disastrous complications because of the close proximity to neural tissue and the surrounding vessels, although rare, serious complications have been reported, such as dural tear, nerve-root irritation, neural injury . Conversely, Nyquists foot drop did not resolve after the screw was removed, which begged the question of whether the foot drop was in fact caused by the misplaced screw. Louw JA, Dommissee GF, Roos MF: Spinal stenosis following anterior spinal fusion. Thus, meaningful efforts to limit the rate of misplaced pedicle and lateral mass screws, such as the routine use of intraoperative imaging confirmation and/or computer- or robot-assisted navigation, should be carefully considered. What can spine surgeons do to improve patient care and avoid medical negligence suits? Moreover, local court rulings are not included in the Westlaw Edge database; however, this is unlikely to present meaningful bias given that malpractice claims are generally filed in state courts. 2014;96(4):266270. 15. 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.

Velocloud Visio Stencils, Izuku Miruko Internship Fanfiction, Vohne Liche Kennels Lawsuit, Scorpio Supernatural Powers, Articles P