pedicle screw misplacement malpractice pedicle screw misplacement malpractice

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. 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. and transmitted securely. Litigation resulted in average payouts of $1,204,422 $753,832 between 1995 and 2019, when adjusted for inflation. 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. Breakage of a divergent screw of a Chopin block at the lumbosacral area was seen 3 months after surgery. 2018;18(2):209215. Weinstein JN, Spratt KF, Spengler D, Brick C, Reid S: Spinal pedicle fixation: Reliability and validity of roentgenogram-based assessment and surgical factors on successful screw placement. 2012;37(1):6776. However, the defendant doctor maintained that Nyquists foot drop was not caused by the misplaced screw. ObjectThe goal of this study was to determine the incidence of screw misplacement and complications in a group of 102 patients who underwent transpedicle screw fixation in the lumbosacral spine with conventional open technique and intraoperative. 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. 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. Pedicle screw insertion in the thoracolumbar spine. 37. 31. J Neurosurg Spine. However, following the spinal fusion, Nyquist began to experience foot drop in her right foot. With pedicle shapes and sizes varying wildly in the scoliotic spine, misplacement of a screwas well as and under- or oversizingare real possibilities in spine surgery. HHS Vulnerability Disclosure, Help Spine 6:263267, 1981. 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. 2017 Mar;5(2):109-116. doi: 10.1016/j.jspd.2016.10.007. 15. J Neurosurg Spine. Cerebrospinal fluid fistulas. 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. Rajasekaran S, Bhushan M, Aiyer S, et al. 2011;365(7):629636. Acta Neurochir (Wien). 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). They both had motor deficits from which 1 patient recovered completely. Orthop Trans 11:99, 1987. All Rights Reserved. Start; O firmie; Usugi; Serwis; Realizacje i porady; Kontakt 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. Dr. Abd-El-Barr is a consultant for Spineology. 2. Re: malpositioned pedicle screw resulting in additional surgery and disability. Retrospective analysis of reasons and revision strategy for failed thoracolumbar fracture surgery by posterior approach: a series of 31 cases. These numbers are in line with the current literature. 4). 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). 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. The instrumentation and bone graft were left in place in these patients (total infection rate, 2.7%). Harrington PR, Tullos HS: Reduction of severe spondylolisthesis in children. Show more. Forty-seven intraoperative and medical complications were observed in 41 patients (36.6%). A total of 247 screws (9.07%) were BMP, 52 (1.91%) were IMP, and 29 (1.06%) were considered SAR. However, only a few complications were related to a poor clinical outcome. Preparation. 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. It should be used by experienced and qualified surgeons who are aware of the pitfalls associated with its use. 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. Despite this problem, the clinical result was excellent. Todd NV. demonstrated that the number of hospital discharges for spinal fusion increased 2.4 times (137%) from 174,223 to 413,171 (p < 0.001) between 1998 and 2008.32 The true frequency of malpositioned pedicle and lateral mass screws is likely underestimated in spine surgery given the fact that the majority of misplaced screws, as well as the potential complications related to them, are not reported in practice and may be clinically silent. Critically revising the article: all authors. 13. 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. 2012;21(suppl 2):S196S199. 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. Friedlander and Bradley will pay half of the $2.25 million. Edwards CC: Spinal screw fixation of the lumbar and sacral spine: Early results treating the first 50 cases. 2018;83(5):9971006. Nyquist had requested the defendants offer, which in retrospect was perhaps a poor decision in light of the Kane County jurys verdict. Unauthorized use of these marks is strictly prohibited. Epstein NE. With increasing pedicle screw usage, the number of patients with misplaced screws will likely increase proportionally. Spine 19:25842589, 1994. Pedicle screw placement safety with the aid of patient-specific guides in a case series of patients with thoracic scoliosis. Copyright © 2023 Becker's Healthcare. Materials and Methods Sixty . Of note, the award amount for one settlement case was undisclosed. EOS System Courtesy of EOS imaging. Spinal fusion procedures are increasingly performed each year, with Deyo et al. Call me tomorrow. Neurosurgery. 16. 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. Epstein NE. Objective: This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. 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. 8600 Rockville Pike 2. Twenty-one patients (18.8%) had thoracolumbar injuries, and loss of immediate postoperative deformity correction ranged from 1.4 to 4.5. Inaccurate pedicle screw placement is relatively common even when placement is performed under fluoroscopic control. Spinal fusion in the United States: analysis of trends from 1998 to 2008. A rod is used to hold the vertebra together to allow fusion to occur. Copyright 2023 Becker's Healthcare. Legal liability in iatrogenic orbital injury. Spine 16:576579, 1991. Spine 13:10121018, 1988. All case demographics are summarized in Table 1. McLaughlin WM, Donnelley CA, Yu K, Gillinov SM, Tuason DA. This retrospective study analyzes the complications and the problems developed during and after pedicle screw fixation in patients with spinal disorders and trauma. Placement of the pedicle screws in the thoracolumbar and lumbar spine is a technically demanding procedure. 2011;213(5):657667. 1. Larson AN, Santos ER, Polly DW Jr, Ledonio CG, Sembrano JN, Mielke CH, Guidera KJ. Am J Orthop. Federal government websites often end in .gov or .mil. J Bone Joint Surg 54A:11951204, 1972. Clinical Orthopaedics and Related Research411:86-94, June 2003. 2012;7(6):e39237. Surg Neurol. The jury found the defendants liable and allocated 75 percent of the fault to Dr. Friedlander and 25 percent to Dr. Bradley. Li HM, Zhang RJ, Shen CL. Careers. 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. The patient had subsequent coronal imbalance and degeneration of the upper disc. In the current study, the arthrodesis rate of 89.4% compares favorably with other previously reported series in the spinal literature, most of which use radiographic means to access the status of the spinal arthrodesis. Yuan HA, Garfin SR, Dickman CA, Mardjetko SM: A historical cohort study of pedicle screw fixation in thoracic, lumbar and sacral spinal fusions. 38. 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. Spine 18:983991, 1993. 27. We also investigated the effect of bone mineral density (BMD), diameter of pedicle screws, and the region of spine on the pullout strength of pedicle screws. Malpractice claims in spine surgery in Germany: a 5-year analysis. 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. Wiltse LL, Spencer CW: New uses and refinements of the paraspinal approach to the lumbar spine. Surg Neurol Int. 2018;43(14):984990. 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. 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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). Privacy Policy. PMC Wolters Kluwer Health Gertzbein SD, Robbins SE: Accuracy of pedicular screw placement in vivo. 2014;21(3):320328. 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. 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. The contact form sends information by non-encrypted email, which is not secure. It should be used by experienced and qualified surgeons who are familiar with the pitfalls associated with its use. In their meta-analysis of nine randomized controlled trials, Li et al. 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. 28. Ann R Coll Surg Engl. 2014 Sep;21(3):320-8. doi: 10.3171/2014.5.SPINE13567. One common area for the potential avoidance of malpractice claims and subsequent payouts involves misplaced pedicle and/or lateral mass instrumentation.