Am J Transl Res. Copyright 2023 Becker's Healthcare. Conclusion: 2. Spine 13:952953, 1988. and transmitted securely. The initial search using the terms above returned 3654 cases. Patient safety: disclosure of medical errors and risk mitigation, Neurosurgical practice liability: relative risk by procedure type. pedicle screw misplacement malpractice. 2022 Sep 15;14(9):6323-6331. eCollection 2022. Spine 14:472476, 1989. On April 6, a Union County, N.J., jury awarded a plaintiff $4.5 million over a botched spine surgery. 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. Complete degeneration of the upper disc developed in two patients who had spinal stenosis and degenerative scoliosis. For more information, please refer to our Privacy Policy. Thus, we are unable to comment on whether all misplaced screws, particularly when asymptomatic, should be revised in an effort to prevent litigation. Zdeblick TA: A prospective randomized study of lumbar fusion: Preliminary results. Spine (Phila Pa 1976). Drafting the article: Sankey. 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. doi: 10.1097/BPO.0000000000001828. Study supervision: Goodwin, Karikari, Shaffrey, Abd-El-Barr, KD Than. Study design: 13 Whitecloud et al 35 reported 15% neurologic complications, 5% being caused by incorrect screw placement. Defensive medicine: a culprit in spiking healthcare costs. 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. Problems in the instrumented segments were considered those occurring from narrowing of the disc space greater than 3 mm, pseudarthrosis, and loss of reduction. Can Postoperative Radiographs Accurately Identify Screw Misplacements? However, the highest offer had been a combined $300,000 from the two defendants. 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. 15. Yuan HA, Garfin SR, Dickman CA, Mardjetko SM: A historical cohort study of pedicle screw fixation in thoracic, lumbar and sacral spinal fusions. You are talking one of the most complicated area of the law. Dr. K. D. Than is a consultant for Bioventus and receives honoraria from DJO and LifeNet Health. The aim of this study is to evaluate the accuracy of pedicle screw insertion in spondylitis tuberculosis kyphosis correction using a freehand technique. Surg Neurol Int. Rajaee SS, Bae HW, Kanim LE, Delamarter RB. The accuracy rate of pedicle screw (PS) placement varies from 85% to 95% in the literature. + 48 696 042 504. 8600 Rockville Pike Materials and Methods Sixty . 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. 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. Pedicle screw insertions are commonly used for posterior fixation to treat various spine disorders. Review of neurosurgery medical professional liability claims in the United States. matte black square deadbolt; roberts point park fishing report; qr code on binax covid test; mff premium character list. Bydon M, Xu R, Amin AG, et al. 2. Schlegel JD, Smith JA, Schleusener RN: Lumbar motion segment pathology adjacent to thoracolumbar, lumbar, and lumbosacral fusions. Cases involving wrong-level or -side surgery, implant malfunction, or other misplaced spinal instrumentation (e.g., interbody cases, rods, surgical instruments, etc.) 31. Clin Orthop 203:4553, 1986. Some error has occurred while processing your request. A total of 47 (69.1%) cases resulted in a decision for the defendant and 21 (30.9%) for the plaintiff. Sethi MK, Obremskey WT, Natividad H, et al. The average followup was 35 months (range, 1851 months). Jena AB, Seabury S, Lakdawalla D, Chandra A. It is easier to confuse a jury than convince a judge: the crisis in medical malpractice. Guzek RH, Mitchell SL, Krakow AR, Harshavardhana NS, Sarkissian EJ, Flynn JM. Epstein NE. 2014;96(4):266270. Placement of thoracolumbar pedicle screws using three-dimensional image guidance: experience in a large patient cohort. None of these complications resulted in additional surgery or in a significant increase of morbidity. Screws were divided into four categories: screws at risk (SAR), indeterminate misplacements (IMP), benign misplacements (BMP), accurately placed (AP). Deyo RA, Mirza SK, Martin BI. 2018;43(14):984990. 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. 26. Spine 19(20 Suppl):2279S2296, 1994. Analysis and interpretation of data: Sankey, TT Than. J Neurosurg Spine. 13 Whitecloud et al 35 reported 15% neurologic complications, 5% being caused by incorrect screw placement. J Neurosurg Spine. 2017;31(3):287288. Ultimately, no significant differences in case demographics were found between plaintiff and defendant judgments (Table 1). This was followed by pseudarthrosis requiring revision surgery, present in 14.3% (n = 3) and 14.9% (n = 7) of plaintiff- and defendant-awarded cases, respectively (p = 0.99). Objective: The medicolegal landscape of spine surgery: how do surgeons fare? Med Econ. Placement of the pedicle screws in the thoracolumbar and lumbar spine is a technically demanding procedure. 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. to maintaining your privacy and will not share your personal information without PURPOSE This study aimed to compare rates of perioperative complications between robotic-assisted and conventional . 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. Clin Orthop 284:8090, 1992. In the other patient, L4L5 float arthrodesis was done. Screw misplacement. 2013;32(1):111119. There were two complete degenerations of the upper disc, one central canal stenosis, and two asymptomatic disc space narrowings and retrolistheses. 33. Defendant-awarded cases by US region (right). 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. Once the spine is exposed, the appropriate levels of fixation are confirmed with the image intensifier. All case demographics are summarized in Table 1. Spine 17:349355, 1992. Determining legal responsibility in otolaryngology: a review of 44 trials since 2008. 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. Your message has been successfully sent to your colleague. Ann R Coll Surg Engl. Orthop Trans 11:99, 1987. 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 physician ordered an MRI of the lumbar spine which showed that the screws had been misplaced and were puncturing the patient's lumbar nerves. 2018;27(9):23392347. Clin Orthop 203:7598, 1986. 1). 2014 Aug 1;14(8):1702-8. doi: 10.1016/j.spinee.2014.03.044. PLoS One. What can spine surgeons do to improve patient care and avoid medical negligence suits? Malpractice liability and defensive medicine: a national survey of neurosurgeons. Spine (Phila Pa 1976). 1. 2020;45(2):E111E119. A CT scan was taken to try and identify the underlying neurological problem that might be causing the new symptom. Using chi square analysis, statistically significant correlation was seen between disc space narrowing and loss of postoperative correction (p < 0.01). The third patient, who had central spinal stenosis, was treated by decompression alone. Finally, considering the problems of balance, it seems that failure to properly evaluate any preexisting scoliosis was a main cause of this important complication. 2013;34(6):699705. Each side was judged separately. 19. McAfee PC, Weiland DJ, Carlow JJ: Survivorship analysis of pedicle spinal instrumentation. St Louis, CV Mosby 322327, 1987. Figure 1: Lower thoracic pedicles provide the firm purchase of the pedicle screw from a lateral starting point and 10-15 degrees convergent angle Surgical technique "Free Hand" pedicle screw placement [50] Our "Free Hand" technique is equivalent for lumbar and In their meta-analysis of nine randomized controlled trials, Li et al. Safety and accuracy of robot-assisted versus fluoroscopy-guided pedicle screw insertion for degenerative diseases of the lumbar spine: a matched cohort comparison. Thirty-five (27.56%) had IMP and 18 (14.17%) had SAR. 3. Nayar G, Blizzard DJ, Wang TY, et al. Please do not include any confidential or sensitive information in a contact form, text message, or voicemail. Neurosurgical practice liability: relative risk by procedure type. Adjusted for age and preoperative Cobb angle, patients with a higher misplacement rate were more likely to have screws . Epub 2014 Apr 4. Seven hundred sixty-three screws were inserted in 138 patients. Taylor CL. J Spine Surg. Din RS, Yan SC, Cote DJ, et al. sharing sensitive information, make sure youre on a federal 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. Misplaced pedicle and lateral mass screws result in a considerable risk of malpractice litigation against spine surgeons. Dr. Abd-El-Barr is a consultant for Spineology. Submitting a contact form, sending a text message, making a phone call, or leaving a voicemail does not create an attorney-client relationship. Lehmann TR, LaRocca HS: Repeat lumbar surgery: A review of patients with failure from previous lumbar surgery treated with spinal canal exploration and lumbar spine fusion. 2011;213(5):657667. 3. Spinal fusion in the United States: analysis of trends from 1998 to 2008. 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. Balch CM, Oreskovich MR, Dyrbye LN, et al. The https:// ensures that you are connecting to the 2013;123(9):20992103. 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. Thu, May 27th, 2021. 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). They both had motor deficits from which 1 patient recovered completely. 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. 8,24,25,32. 2011;365(7):629636. Back pain/spinal stenosis and neurogenic claudication/radiculopathy were the most frequently reported indications for the index surgery, accounting for 13 (19.1%) and 11 (16.2%) cases, respectively. Abstract BACKGROUND CONTEXT Surgeons have increasingly adopted robotic-assisted lumbar spinal fusion due to indications that robotic-assisted surgery can reduce pedicle screw misplacement. Copyright 1944-2023 American Association of Neurological Surgeons, Copy this link, or click below to email it to a friend. * 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. Safety and efficacy of pedicle screw placement using intraoperative computed tomography: consecutive series of 1148 pedicle screws. However, the medicolegal impact of misplaced screws on spine surgery has not been directly reported in the literature. 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 13:10121018, 1988. Gertzbein SD, Robbins SE: Accuracy of pedicular screw placement in vivo. Both of these patients complained of thigh pain but refused any additional surgery. 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. Bookshelf 1,12,19,22 The largest series of adjacent segment breakdown was reported by Schlegel et al. 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. In order to prove medical malpractice occurred, the plaintiffs attorney needs to show not only the plaintiff experienced a poor medical outcome, but that it was directly caused by medical negligence. 28. Brodsky AE: Post-laminectomy and post-fusion stenosis of the lumbar spine. 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. Mean amounts awarded SD to plaintiffs by jury trial (n = 13) versus settlement/arbitration (n = 7), adjusted for inflation as of April 2020. Debate Over Extent of Eye Damage Following Implant Lens Surgery Leads to $1 Million Verdict in Zaleski v Elmhurst Eye Surgery Center. 3. Cookie Policy. Epstein NE. Also notable, only one claim reported the use of intraoperative CT and was ultimately ruled in favor of the defendant. 11. 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. At the lumbosacral area, breakage of a divergent screw of a Chopin block occurred on only one side with no loss of correction. Am J Otolaryngol. Studdert DM, Mello MM, Sage WM, et al. 20th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference, 8th Annual Health IT + Digital Health + RCM Conference, 29th Annual Meeting - The Business & Operations of ASCs, The issues spine surgeons are advocating for outside of the operating room, Centinel Spine is now covered by all major payers, What's next for SI joint fusion? The third surgical procedure removed the pedicle screws but left the patient in an unfused state with an unstable spine. Methods: shooting in valdosta leaves one dead However, we did not observe any screw breakage in patients with a degenerative lumbar spine, and the absence of broken screws in this series is because arthrodesis in almost all patients occurred in situ. Introduction. A total of 2724 screws were placed in 127 patients. Rynecki ND, Coban D, Gantz O, et al. 30. Another possible cause was the high lateral torques to the entire frame that occurred during tightening of the tulip screw. 2011;306(10):1088. In White AH, Rothman RH, Ray CD (eds). 22. Spine (Phila Pa 1976). You may be trying to access this site from a secured browser on the server.
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