(PDF) Accuracy of pedicle screw placement in the lumbosacral spine Partner, Paul M. da Costa, Obtains $4.5 Million Verdict - Snyder Sarno J Bone Joint Surg 54A:11951204, 1972. Spine 6:263267, 1981. Legal liability in iatrogenic orbital injury. 32. 2018;29(4):397406. Spine 15:908912, 1990. One common area for the potential avoidance of malpractice claims and subsequent payouts involves misplaced pedicle and/or lateral mass instrumentation. SECTION I SYMPOSIUM: Advances in Spine Surgery, Distribution of Spinal Disorders in 112 Patients, Classification of Complications in 64 patients. Accuracy of fluoroscopically-assisted pedicle screw placement: analysis of 1,218 screws in 198 patients. Pullout strength of misplaced pedicle screws in the thoracic and lumbar 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. 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. Jena AB, Seabury S, Lakdawalla D, Chandra A. 70% of Pedicle Screws are misplaced - orthostreams.com 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. 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. None of these complications resulted in additional surgery or in a significant increase of morbidity. Pullout performance comparison of pedicle screws based on cement Misplaced pedicle and lateral mass screws result in a considerable risk of malpractice litigation against spine surgeons. However, despite the apparent widespread use of pedicle system fixation, few studies of problems and particularly complications have been published. Nyquist had requested the defendants offer, which in retrospect was perhaps a poor decision in light of the Kane County jurys verdict. Debate Over Extent of Eye Damage Following Implant Lens Surgery Leads to $1 Million Verdict in Zaleski v Elmhurst Eye Surgery Center. Would you like email updates of new search results? Pedicle screw insertion in the thoracolumbar spine. Clin Orthop 203:717, 1986. 1. In our opinion, these problems may be prevented by applying the following principles: limitation of spine arthrodesis to the pathologic levels, inclusion of already extensive changes at the level above or below the planned arthrodesis into the arthrodesis, restoration of postoperative sagittal and coronal alignment, and avoidance of impingement syndrome from the adjacent nonfused facets. doi: 10.1097/BPO.0000000000001828. Quraishi NA, Hammett TC, Todd DB, et al. When adjusted for inflation, these values increased to $1,330,201 $882,023 versus $970,832 $381,619, respectively (p = 0.32; Fig. Results: Spine 17:349355, 1992. 2018;41(5):e615e620. 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. Pedicle screw insertions are commonly used for posterior fixation to treat various spine disorders. CT-navigation versus fluoroscopy-guided placement of pedicle screws at 2022 Jun;8(2):234-241. doi: 10.21037/jss-22-28. However, the defendant doctor maintained that Nyquists foot drop was not caused by the misplaced screw. 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. Seven hundred sixty-three screws were inserted in 138 patients. 2014;21(3):320328. Ahmadi SA, Sadat H, Scheufler KM, et al. However, the misplacement of pedicle screws can lead to disastrous complications. Cookie Policy. Crawford MJ, Esses SI: Indications for pedicle fixation: Results of NASS/SRS faculty questionnaire: North American Spine Society and Scoliosis Research Society. pedicle screw: A rigid surgical implant used to stabilize adjacent spinal segments in spinal fusion surgery. The defendants explanation provided an explanation for why Nyquists foot drop did not resolve after the misplaced screw was removed and shed doubt on the plaintiffs theory of liability. Illinois Jury Finds in Favor of Doctor in Gallbladder Surgery that Led to Fatal Bowel Perforation Nickl v. Barry S. Rosen, M.D. 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. single homes for sale in lehigh valley, pa 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. Am J Otolaryngol. Analysis and interpretation of data: Sankey, TT Than. Eur Spine J. 6. 2014;96(4):266270. Clin Orthop 227:1023, 1988. Among the plaintiff-awarded cases, 13 (61.9%) were decided by jury trial, 7 (33.3%) by settlement, and 1 (4.8%) by arbitration. Hardware-related failures were observed in 12 patients (10.7%). 2 One of the first obstacles regarding . 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. Dr. K. D. Than is a consultant for Bioventus and receives honoraria from DJO and LifeNet Health. The accuracy rate of pedicle screw (PS) placement varies from 85% to 95% in the literature. Procedural errors led to combined payouts totaling $124,943,933 in neurosurgery claims between 2003 and 2012 in a study looking at data from the Physician Insurers Association of America Data Sharing Project.10 However, our study is the first to report the direct medicolegal impact of screw misplacement on US spine surgery, with 30.9% of judgments/settlements in favor of the plaintiff, resulting in average payouts of $1,204,422 $753,832 per claim. They both had motor deficits from which 1 patient recovered completely. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 35. What can spine surgeons do to improve patient care and avoid medical negligence suits? All the incidental dural tears were repaired immediately and produced no clinical sequelae. Per-patient analysis reveals more concerning numbers toward screw misplacement. Orthopedics. Robotic-assisted pedicle screw placement fails to reduce overall In the current series, there were no cases of screw misplacement or vascular or neurologic complications caused by implant application. 8. Rynecki ND, Coban D, Gantz O, et al. Jury awards $4.5M over misplaced pedicle screw during spine surgery: 5 The average age of the patients was 47 years and the average followup was 35 months. Please try again soon. The medicolegal landscape of spine surgery: how do surgeons fare? 2014;75(6):609613. West et al 33 also reported a 29% complication rate for the first 50 patients and a 26% complication rate for the last 74 patients. There were nine instrumentation failures at the thoracolumbar area (seven patients), lumbar area (one patient), and lumbosacral area (one patient). The instrumentation and bone graft were left in place in these patients (total infection rate, 2.7%). 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. 2018;18(2):209215. The patient had to undergo a subsequent surgery to remove the pedicles. Your message has been successfully sent to your colleague. Malpractice liability and defensive medicine: a national survey of neurosurgeons. 4). In the remaining patients, the standard construct was three-segment fixation spanning four vertebrae and three discs, two above and one below the fractured vertebra, using six screws. 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. 1 Although this technique has advantages over open instrumentation, it also presents new challenges and specific complications. Some error has occurred while processing your request. Drafting the article: Sankey. 36. However, this is the first study to evaluate the direct medicolegal impact of misplaced pedicle and lateral mass screws on spine surgery in the US and presents important information that may support the routine use of intraoperative imaging confirmation (via 3D fluoroscopy or intraoperative CT) and/or navigated screw placement (either computer- or robot-assisted) as a potential method to decrease the risk of future litigation during spinal fusion procedures. Eur Spine J. 16,24,28 Simultaneously, the evolution of the surgical techniques has led to increased procedural safety. Svider PF, Kovalerchik O, Mauro AC, et al. Autor de la entrada Por ; Fecha de la entrada austin brown musician; matrix toners for bleached hair . 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. 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. 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). + 48 696 042 504. This retrospective study analyzes the complications and the problems developed during and after pedicle screw fixation in patients with spinal disorders and trauma. The patient had subsequent coronal imbalance and degeneration of the upper disc. 10. JAMA. Using chi square analysis, statistically significant correlation was seen between disc space narrowing and loss of postoperative correction (p < 0.01). (A) Anteroposterior and (B) lateral radiographs taken 2 years after surgery show unilateral pseudarthrosis in a 55-year-old man with spinal stenosis. Comparison of pedicle screw placement accuracy between two types of These complications may have resulted from powerful bending movement acting on the screw at its entry point to the bone. Screw misplacement. All of these patients were asymptomatic and had satisfactory final clinical outcomes (Fig 2). Lumbar Spine Surgery. Pitfall: Unstable injuries. Please enable it to take advantage of the complete set of features! At the trials close, the plaintiffs attorney had asked the jury to return a $5.3 million verdict and had made a prior demand to settle the medical malpractice lawsuit for $1 million. 16. Spine surgery has been disproportionately impacted by medical liability and malpractice litigation, with the majority of claims and payouts related to procedural error. 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. Safety and efficacy of pedicle screw placement using intraoperative computed tomography: consecutive series of 1148 pedicle screws. Rajasekaran S, Bhushan M, Aiyer S, et al. 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. and 17.1% of the patients included had at least one screw misplaced. Using Low-Dose, Biplanar Imaging to Reduce Screw Misplacement. Facebook Google Plus Youtube RSS Email. J Neurosurg Spine. A rod is used to hold the vertebra together to allow fusion to occur. 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). Hsu K, Zucherman JF, White AH: Internal Fixation With Pedicle Screws. 17. Spine 13:952953, 1988. Spine neurosurgeons facing the judicialization of their profession: disenchantment and alteration of daily practicea qualitative study. JAMA Intern Med. Spine 18:983991, 1993. Am J Transl Res. 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. PURPOSE This study aimed to compare rates of perioperative complications between robotic-assisted and conventional . 2016;124(5):15241530. Three slender patients complained of soft tissue irritation and a bothersome prominence because of the screws bulky profile. J Spine Surg. Clin Orthop 284:8090, 1992. Pedicle Screw Insertion in Spondylitis Tuberculosis | ORR Unfortunately, the plaintiffs attorney was unable to offer an alternative theory of surgical negligence that would refute the defendants explanation. Yuan HA, Garfin SR, Dickman CA, Mardjetko SM: A historical cohort study of pedicle screw fixation in thoracic, lumbar and sacral spinal fusions. A total of 2724 screws were placed in 127 patients. 2017;42(3):177185. Similar to our findings, prior studies have shown that settlements result in lower payouts than cases that are ultimately taken to trial,7,14,15,30 with awards ranging from $125,000 to $9,000,000 compared to $134,000 to more than $38,000,000.7,15 Nevertheless, the true financial toll on spine surgery is largely unknown given that 85% of cases are dismissed or settled out of court, with undisclosed amounts.14 Likewise, substantial time is spent and costs, including legal and administrative, are incurred before judgment, as noted above. Additional survey data have shown that 50% of physicians exhibit at least a temporary loss of self-esteem after a malpractice claim, and at least 25% experience depression.22 As stated above, the average neurosurgeon spends 27.2% of his or her entire career in an open malpractice claim,10 and each case can take an average of 5.1, 5.0, and 3.4 years for defendant verdicts, plaintiff rulings, and settlements, respectively.7,15 Likewise, neurosurgeons have a higher risk than practitioners in other specialties of being named in multiple malpractice suits given the particularly high-risk nature of the specialty.10 Even when found in favor of the defendant (surgeon), each case ultimately takes a substantial emotional and financial toll on the physician(s) involved. The average followup was 35 months (range, 1851 months). Taylor CL. Reoperation for Misplaced Pedicle Screws: A Multicenter Retrospec 2016;25(3):716723. Scarone P, Vincenzo G, Distefano D, et al. Bydon M, Xu R, Amin AG, Macki M, Kaloostian P, Sciubba DM, Wolinsky JP, Bydon A, Gokaslan ZL, Witham TF. Bethesda, MD 20894, Web Policies 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). (A) Anteroposterior and (B) lateral radiographs taken 1 year after surgery show upper screw breakage in the application of a short Cotrel-Dubousset construct in a T12 burst fracture. Delayed open treatment of aortic penetration by a thoracic pedicle 28. First, this is a retrospective analysis of cases obtained from the web-based Westlaw Edge legal research database. Level of evidence: 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). Johnston II CE, Ashman RB, Baird AM, Allard RN: Effect of spinal construct stiffness on early fusion mass incorporation: Experimental study. This site needs JavaScript to work properly. The total number of reoperations for MPS and patient clinical data were obtained from medical records at each hospital. In six patients (5.3%) with degenerative spine disease, the disc material had been removed. Neurosurgery. J Neurosurg Spine. 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. Epub 2022 Oct 29. 2006;65(4):416421. Recently, robot-assisted pedicle screw implantation has been increasingly utilized at large-volume academic centers. The medicolegal impact of misplaced pedicle and lateral mass screws on 1). A CT scan was taken to try and identify the underlying neurological problem that might be causing the new symptom. Spine 18:18621866, 1993. Spinal fusion in the United States: analysis of trends from 1998 to 2008. A total of 247 screws (9.07%) were BMP, 52 (1.91%) were IMP, and 29 (1.06%) were considered SAR. I won't be at the office but I will check my voice mail. Better strategies need to be devised for evaluation of screw placement, including establishment of a national database of deformity surgery, use of intra-operative image guidance, and reevaluation of postoperative low-dose CT imaging. 0 attorneys agreed. PDF Intraoperative biomechanics of lumbar pedicle screw loosening following