Malpractice litigation following spine surgery. A p < 0.05 was considered statistically significant. Accuracy and workflow of navigated spinal instrumentation with the mobile AIRO CT scanner. Guzek RH, Mitchell SL, Krakow AR, Harshavardhana NS, Sarkissian EJ, Flynn JM. An official website of the United States government. All the incidental dural tears were repaired immediately and produced no clinical sequelae. Hsu K, Zucherman JF, White AH: Internal Fixation With Pedicle Screws. In the other patient, L4L5 float arthrodesis was done. 19. Spine 13:952953, 1988. Spine 15:1114, 1990. The rod is held in place by "pedicle screws," which the surgeon must insert into the pedicles. 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. Comparetto, Esq., 727-328-7900, www.florida-malpractice-lawyers.com. Ultimately, no significant differences in case demographics were found between plaintiff and defendant judgments (Table 1). 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. Todd NV. 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. JAMA. Pedicle screw placement is a common procedure. Clinical Orthopaedics and Related Research, Get new journal Tables of Contents sent right to your email inbox, The Association of Bone and Joint Surgeons, Complications and Problems Related to Pedicle Screw Fixation of the Spine, Articles in Google Scholar by Pavlos Katonis, MD, Other articles in this journal by Pavlos Katonis, MD, Privacy Policy (Updated December 15, 2022). Call me tomorrow. Reprint requests to Pavlos Katonis, MD, 99 Minoos & Thenon Street, 71305, Heraklion, Crete, Greece. Per-patient analysis showed 23 (18.11%) of patients had all screws AP. 2016;25(3):716723. When adjusted for inflation, these values increased to $1,330,201 $882,023 versus $970,832 $381,619, respectively (p = 0.32; Fig. Wolters Kluwer Health Spine 17:834837, 1992. Epstein NE. Determining legal responsibility in otolaryngology: a review of 44 trials since 2008. Plaintiff award amounts were adjusted for inflation as of April 2020 using an online inflation calculator provided by the US Bureau of Labor Statistics (https://www.bls.gov/data/inflation_calculator.htm). 2021 Nov 26;22(1):986. doi: 10.1186/s12891-021-04860-y. 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. Personal consequences of malpractice lawsuits on American surgeons. 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. However, following the spinal fusion, Nyquist began to experience foot drop in her right foot. Plaintiff-awarded cases by US region (left). Spine 13:696706, 1988. Mukherjee S, Pringle C, Crocker M. A nine-year review of medicolegal claims in neurosurgery. On April 6, a Union County, N.J., jury awarded a plaintiff $4.5 million over a botched spine surgery. Spine 13:10121018, 1988. J Neurosurg Spine. Spine 16(8 Suppl):S455458, 1991. To prevent general complications, it is evident that precise and careful soft tissue handling, proper irrigation, and debridement during and after surgery, decrease of operative time, and proper patient monitoring postoperatively must be done. 2019;19(7):12211231. Achieving proper lumbar lordosis, evaluating any preexisting scoliosis, and intraoperative assessment with AP radiographs could prevent balance problems. 28. 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. 1. Each case was then carefully screened for relevance and sufficient data. The intent is to provide relief from pain and nerve damage. Although the rationale for using pedicle screw fixation is fairly clear, controversy continues regarding the application of pedicle instrumentation for spine arthrodesis, especially on the degenerative lumbar spine. The most frequent primary injury listed for a lawsuit was nerve root injury, present in 81.0% (n = 17) and 74.5% (n = 35) of plaintiff- and defendant-awarded cases, respectively (p = 0.7). J Bone Joint Surg 54A:11951204, 1972. George Sapkas, MD, DSc; and Panayiotis J. Papagelopoulis, MD, DScGuest Editors. These complications may have resulted from powerful bending movement acting on the screw at its entry point to the bone. This step in implant evolution was inevitable, because prior phases of implant development did not control each plane of motion segment stress. Br J Neurosurg. Malpractice litigation and the spine: the NHS perspective on 235 successful claims in England. 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). Johnston II CE, Ashman RB, Baird AM, Allard RN: Effect of spinal construct stiffness on early fusion mass incorporation: Experimental study. The patient had to undergo a subsequent surgery to remove the pedicles. J Neurosurg Spine. Two patients had an acute infection develop for which they required operative intervention with irrigation and debridement. Spine 6:615619, 1981. Nahed BV, Babu MA, Smith TR, Heary RF. There were nine instrumentation failures at the thoracolumbar area (seven patients), lumbar area (one patient), and lumbosacral area (one patient). The last two patients had a T12L1 fracture-dislocation and a L4L5 spondylolytic spondylolisthesis at the site of plug dislodgments. 2020;162(6):13791387. 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. Clipboard, Search History, and several other advanced features are temporarily unavailable. 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 . All of these patients were asymptomatic and had satisfactory final clinical outcomes (Fig 2). were excluded from analysis. 6. In six of these patients with injuries at the thoracolumbar area (four patients with bent screws and two patients with broken screws), the loss of correction ranged from 3 to 4.5 without change of anatomic reduction (Fig 1). Laryngoscope. The rate of medical complications was 8%. Med Econ. $ = US$; MW = Midwest; NE = Northeast; SE = Southeast; SW = Southwest; W = West. In addition, hardware failures were observed in 12 patients (10.7%), junctional problems were seen in five patients (4.5%), problems in the instrumented segments were seen in 39 patients (34.7%), and problems of balance occurred in five patients (4.5%). 22. Dr. Karikari is a consultant for NuVasive, Globus, Johnson & Johnson, and DePuy and receives a spine fellowship fund from NuVasive. [] The accuracy for free-hand screw placement technique varies from 69% to 94%. 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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. Mohar J, Vali M, Podovovnik E, Mihali R. Eur Spine J. 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. 2. 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. Problems of balance were coronal (scoliosis greater than 5 or trunk shift greater than 5 mm) as seen on the AP radiograph taken with the patient standing or sagittal (failure to obtain or maintain lumbar lordosis). Spine (Phila Pa 1976). 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). This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. A TLIF is a surgical procedure that attempts to fuse vertebrae in order to stabilize the patient's spine. Scarone P, Vincenzo G, Distefano D, et al. Except for two patients with spinal metastatic disease, all other patients received an iliac crest autologous bone grafts. The screws were needed to stabilize the spine and fix the fused vertebrae in place. Pedicle screw placement safety with the aid of patient-specific guides in a case series of patients with thoracic scoliosis. J Neurosurg Spine. Morphometric analysis of the proximal thoracic pedicles in Lenke II and IV adolescent idiopathic scoliosis: an evaluation of the feasibility for pedicle screw insertion. Autor de la entrada Por ; Fecha de la entrada austin brown musician; matrix toners for bleached hair . 2014 Aug 1;14(8):1702-8. doi: 10.1016/j.spinee.2014.03.044. Although the rate of the reported complications was high, the final outcome of the patients was not affected significantly. J Bone Joint Surg 73A:11791184, 1991. This device was used with an early version of the Cotrel-Dubousset instrumentation to provide sacral fixation and it is rarely used since the more widespread use of newer spine fixation systems. Please enable scripts and reload this page. In several of the studies in the spinal literature, the contention that instrumentation improves arthrodesis rates, considering that nonunion contributes to a poor outcome in spinal arthrodesis is favored. Please enable it to take advantage of the complete set of features! Pedicle screw insertions are commonly used for posterior fixation to treat various spine disorders. One of the patients had a late wound infection develop that was treated by radical debridement and removal of instrumentation. pedicle screw misplacement malpractice.
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