All case demographics are summarized in Table 1. Edwards CC: Spinal screw fixation of the lumbar and sacral spine: Early results treating the first 50 cases. Guzek RH, Mitchell SL, Krakow AR, Harshavardhana NS, Sarkissian EJ, Flynn JM. (%), Pseudarthrosis requiring revision surgery. 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). The third surgical procedure removed the pedicle screws but left the patient in an unfused state with an unstable 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. Louw JA, Dommissee GF, Roos MF: Spinal stenosis following anterior spinal fusion. The third patient, who had central spinal stenosis, was treated by decompression alone. Show more. 2014 Aug 1;14(8):1702-8. doi: 10.1016/j.spinee.2014.03.044. A total of 2396 screws were placed accurately (87.96%). Dr. K. D. Than is a consultant for Bioventus and receives honoraria from DJO and LifeNet Health. Malpractice litigation and the spine: the NHS perspective on 235 successful claims in England. Hecht N, Kamphuis M, Czabanka M, et al. 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. Complete degeneration of the upper disc developed in two patients who had spinal stenosis and degenerative scoliosis. 12. pedicle screw: A rigid surgical implant used to stabilize adjacent spinal segments in spinal fusion surgery. 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. Pedicle screw insertions are commonly used for posterior fixation to treat various spine disorders. Katonis, Pavlos MD*; Christoforakis, Joseph MD*; Aligizakis, Agisilaos C. MD*; Papadopoulos, Charalampos MD*; Sapkas, George MD, DSc**; Hadjipavlou, Alexander MD*. Several limitations should be carefully considered when interpreting our results. Screw Malposition: Are There Long-term Repercussions to Malposition of Pedicle Screws? The accuracy rate of pedicle screw (PS) placement varies from 85% to 95% in the literature. [] Computer-assisted computed tomography (CT) techniques have improved the overall accuracy for pedicle screw placement, and has reduced complication rates. 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). Subjects were 10,754 patients (73,777 pedicle screws) who underwent PSF at 11 hospitals over 15 years. 1. Katonis PG, Kontakis GM, Loupasis GA, et al: Treatment of unstable thoracolumbar and lumbar spine injuries using Cotrel-Dubousset instrumentation. Rajasekaran S, Bhushan M, Aiyer S, et al. 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. South Med J 62:17, 1969. 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. Segal J. Spine neurosurgeons facing the judicialization of their profession: disenchantment and alteration of daily practicea qualitative study. 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. Feb. 16, 2021 Accurate placement of pedicle screws is key to avoiding the potential complications of spinal fusion surgery and improving overall spinal fixation. 5 Those authors recommend that particular care should be taken in inserting the washers without cross threading and ensuring that they are locked down tightly, with an adequate length of rod protruding beyond the screw. Lorenz M, Zindrick M, Schwaegler P, et al: A comparison of single level fusion with and without hardware. 2011;213(5):657667. 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%). 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. Debate Over Extent of Eye Damage Following Implant Lens Surgery Leads to $1 Million Verdict in Zaleski v Elmhurst Eye Surgery Center. 2018;28(2):186193. The rate of medical complications was 8%. Epub 2022 Oct 29. 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). 24. 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 ]. Spine surgery has been disproportionately impacted by medical liability and malpractice litigation, with the majority of claims and payouts related to procedural error. Dr. Abd-El-Barr is a consultant for Spineology. While the majority of claims are found to lack merit, resulting in a verdict in favor of the defendant or case dismissal,7,1316 at least 37% are considered valid.26 Regardless, payouts to plaintiffs are often substantial, averaging in the hundreds of thousands to millions of dollars in both the US and Europe.10,11,14,17,20 Communication of errors and expectations, thorough documentation, and selection of appropriate patients and surgical indications have been shown to reduce the likelihood of a successful malpractice claim.13,16,27,28 In addition, attempts at tort reform in some states have helped limit the financial burden of medical malpractice payouts through methods such as capitation.16,20,22,26 However, efforts to limit malpractice claims in the first place are greatly needed. One of the patients had a late wound infection develop that was treated by radical debridement and removal of instrumentation. Forty-seven intraoperative and medical complications were observed in 41 patients (36.6%). INCLUDE WHEN CITING DOI: 10.3171/2020.8.FOCUS20600. pedicle screw misplacement malpractice. HHS Vulnerability Disclosure, Help Two-dimensional (2D) fluoroscopy-guided percutaneous pedicle screw (PPS) placement is currently the most widely applied instrumentation for minimally invasive treatment of spinal injuries requiring stabilization. (A) Anteroposterior and (B) lateral radiographs taken 2 years after surgery show unilateral pseudarthrosis in a 55-year-old man with spinal stenosis. 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. The .gov means its official. With increasing pedicle screw usage, the number of patients with misplaced screws will likely increase proportionally. Some error has occurred while processing your request. 2014;96(4):266270. 2005;293(21):26092617. Whitecloud III TS, Butler JC, Cohen JL, Candelora PD: Complications with the variable spinal plating system. 5. Nayar G, Blizzard DJ, Wang TY, et al. Using chi square analysis, statistically significant correlation was seen between disc space narrowing and loss of postoperative correction (p < 0.01). 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. McAfee PC, Weiland DJ, Carlow JJ: Survivorship analysis of pedicle spinal instrumentation. 5. 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%). Spine 6:263267, 1981. The remaining two patients had asymptomatic junctional problems develop after two- and three-segment fusions, at the third and fourth postoperative year, respectively. PLoS One. 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. J Bone Joint Surg 45A:11591170, 1963. None of these complications resulted in additional surgery or in a significant increase of morbidity. 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. Three slender patients complained of soft tissue irritation and a bothersome prominence because of the screws bulky profile. Harrington and Tullos 11 first reported the technique of transpedicle screw fixation, and Roy-Camille et al 23 popularized the first practical method of pedicle screw fixation. The plaintiff underwent revision surgery in May 2013. 16,24,28 Simultaneously, the evolution of the surgical techniques has led to increased procedural safety. Seabury SA, Chandra A, Lakdawalla DN, Jena AB. $ = US$. Conception and design: Sankey, KD Than. The suit claimed Dr. Friedlander failed to diagnose and treat the mispositioned screw in a timely manner, leading the plaintiff to develop pain in his right leg, numbness in his right calf and weakness in his right toes. A total of 2724 screws were placed in 127 patients. matte black square deadbolt; roberts point park fishing report; qr code on binax covid test; mff premium character list. your express consent. 2014 Sep;21(3):320-8. doi: 10.3171/2014.5.SPINE13567. reporting that the number of Medicare patients who underwent a complex lumbar spine fusion for spinal stenosis increased 15-fold, from 1.3 persons per 100,000 Medicare persons in 2002 to 19.9 in 2007.31 Similarly, a study by Rajaee et al. Schatlo B, Molliqaj G, Cuvinciuc V, et al. Aigner R, Bichlmaier C, Oberkircher L, Knauf T, Knig A, Lechler P, Ruchholtz S, Frink M. BMC Musculoskelet Disord. Dr. Karikari is a consultant for NuVasive, Globus, Johnson & Johnson, and DePuy and receives a spine fellowship fund from NuVasive. J Neurosurg Spine. Privacy Policy. You may be trying to access this site from a secured browser on the server. I won't be at the office but I will check my voice mail. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. Please enable scripts and reload this page. 32. Linking and Reprinting Policy. 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. The intent is to provide relief from pain and nerve damage. 2012 Feb 1;37(3):E188-94. Placement of the pedicle screws in the thoracolumbar and lumbar spine is a technically demanding procedure. One common area for the potential avoidance of malpractice claims and subsequent payouts involves misplaced pedicle and/or lateral mass instrumentation. J Neurosurg Spine. This study revealed an overall accuracy rate of 95.2% of mainly percutaneously inserted pedicle screws according to the classification of Zdichavsky et al. To reinforce spinal fixation, we have proposed a construct with segmental pedicle fixation two levels above and one level below the injured level and insertion of a screw deep into the pedicle, providing more contact area between screw head and bone and reducing the moment arm of the bending stress. 19. It should be used by experienced and qualified surgeons who are aware of the pitfalls associated with its use. All Rights Reserved. Phone/Fax: 30-2810-318361; E-mail: [emailprotected]. 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). 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. Erwin WD, Dickson JH, Harrington PR: Clinical review of patients with broken Harrington rods. Thus, in the current study we aimed to describe this impact in the US, as well as to suggest a potential method for mitigating the problem. Medical malpractice in orthopedic surgery: a Westlaw-based demographic analysis. 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. Submitting a contact form, sending a text message, making a phone call, or leaving a voicemail does not create an attorney-client relationship. We attribute the 24.1% disc space narrowing in the instrumented segments mainly to the severe injury of the disc and communication of the end plate in burst fractures, which could accelerate the disc degeneration and narrowing. Both of these patients complained of thigh pain but refused any additional surgery. Administrative/technical/material support: Mehta, Wang, KD Than. Autor de la entrada Por ; Fecha de la entrada austin brown musician; matrix toners for bleached hair . Call Us Now For a Free Consultation | Toll Free: 800.583.8002 | Local: 312.346.0045, Cook County Surgeons Cut Common BIle Duct During Surgery, But Jury Finds for Defendants , Illinois Jury Finds in Favor of Doctor in Gallbladder Surgery that Led to Fatal Bowel Perforation , Debate Over Extent of Eye Damage Following Implant Lens Surgery Leads to $1 Million Verdict in, $75 Million Jury Verdict in Failure to Timely Diagnose Stroke, $18 Million Jury Verdict in Late Diagnosis of Breast Cancer, $300,000 Settlement for Excessive Use of Radiation, Chicago Medical Malpractice Lawyer Kreisman Law Offices Home, Contact Illinois Personal Injury Attorney Kreisman Law Offices. Can Postoperative Radiographs Accurately Identify Screw Misplacements? Determining legal responsibility in otolaryngology: a review of 44 trials since 2008. 2022 Dec;31(12):3544-3550. doi: 10.1007/s00586-022-07427-0. Accuracy and workflow of navigated spinal instrumentation with the mobile AIRO CT scanner. Pedicle screws have been used to treat spinal disorders, including those caused by spinal cancer, congenital anomalies, trauma, and chronic pain syndromes. 2018;83(5):9971006. Excessive hemorrhage occurred in two patients (1.8%) with coagulation disorders. Spine 15:1114, 1990. There were 74 men and 38 women, with a mean age of 47 years (range, 1872 years). Of note, the award amount for one settlement case was undisclosed. Analysis and interpretation of data: Sankey, TT Than. West III JL, Bradford DS, Ogilvie JW: Results of spinal arthrodesis with pedicle screw-plate fixation. However, the highest offer had been a combined $300,000 from the two defendants. doi: 10.1097/BPO.0000000000001828. Careers. Yuan HA, Garfin SR, Dickman CA, Mardjetko SM: A historical cohort study of pedicle screw fixation in thoracic, lumbar and sacral spinal fusions. 37. 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. 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. 2021 Jul 1;41(Suppl 1):S80-S86. 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 problems were those related to the physical change of metal and screw position. J Neurosurg Spine. Clinical Orthopaedics and Related Research411:86-94, June 2003. 2017;27(4):470475. 8. 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. Intraoperative and postoperative complications were recorded by the authors and the results were evaluated by an independent observer. 2021 Nov;9(6):1541-1548. doi: 10.1007/s43390-021-00377-5. Nyquist had requested the defendants offer, which in retrospect was perhaps a poor decision in light of the Kane County jurys verdict. Thus, we are unable to comment on whether all misplaced screws, particularly when asymptomatic, should be revised in an effort to prevent litigation. 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. MeSH Mason A, Paulsen R, Babuska JM, et al. However, the impact of robotic-assisted spinal fusion on patient outcomes is less clear. Start; O firmie; Usugi; Serwis; Realizacje i porady; Kontakt Clin Orthop 203:717, 1986. Call me tomorrow. St Louis, CV Mosby 322327, 1987. 9. The development of the transpedicle screw has provided control of the vertebral motion segment in each plane, resisting any type of load. Your message has been successfully sent to your colleague. 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. It was firstly introduced by Harrington and Tullos in 1969 and then in late 1980s developed by Roy Camille et al., Louis, and Steffe. After the removal of duplicates, a total of 68 unique cases met our inclusion criteria and were included for analysis. Jury awards $4.5M over misplaced pedicle screw during spine surgery: 5 things to know Spine Monday, May 7th, 2018 Post Listen Text Size On April 6, a Union County, N.J., jury awarded a plaintiff $4.5 million over a botched spine surgery. 27. Health Aff (Millwood). Clipboard, Search History, and several other advanced features are temporarily unavailable. Bethesda, MD 20894, Web Policies Eur Spine J. 2013;34(6):699705. Malpractice claims in spine surgery in Germany: a 5-year analysis. A Cotrel-Dubousset spinal system (Medtronic Sofamor Danek, Memphis, TN) was used in all patients and the total number of screws used was 658. 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. 2012;41(2):6973. 2016;124(5):15241530. First, this is a retrospective analysis of cases obtained from the web-based Westlaw Edge legal research database. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 16. 11. 3. 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. Ahmadi SA, Sadat H, Scheufler KM, et al. Two patients had an acute infection develop for which they required operative intervention with irrigation and debridement. Overall reported screw misplacement is low, but it does not reflect the potential impact on patient morbidity. However, the defendant doctor maintained that Nyquists foot drop was not caused by the misplaced screw. Cerebrospinal fluid fistulas. Schlegel JD, Smith JA, Schleusener RN: Lumbar motion segment pathology adjacent to thoracolumbar, lumbar, and lumbosacral fusions. Personal consequences of malpractice lawsuits on American surgeons. Spine J. PMC were excluded from analysis. Dr. Goodwin has received grants from the Burroughs Wellcome Fund, North Carolina Spine Society, and Robert Wood Johnson Harold Amos Medical Faculty Development Program and the NIH/NINDS K12 NRCDP Physician Scientist Award. Percentage of cases per US region (center). 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. 17. Am J Orthop. All Rights Reserved. Elizabeth Hofheinz, M.P.H., M.Ed. Accuracy of C2 pedicle screw placement using the anatomic freehand technique. 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). Reviewed submitted version of manuscript: all authors. Studdert DM, Mello MM, Sage WM, et al. 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 At the lumbosacral area, breakage of a divergent screw of a Chopin block occurred on only one side with no loss of correction. The standard imaging technique for pedicle screw insertion is two-dimensional images obtained from C-arm-type X-ray fluoroscopy. The medicolegal landscape of spine surgery: how do surgeons fare? Pedicle screw placement safety with the aid of patient-specific guides in a case series of patients with thoracic scoliosis. 13. It has a great developing technique that is used for fixation and fusion in spine surgery. Amount awarded to plaintiffs by US region, adjusted for inflation as of April 2020. To prevent the development of pseudarthrosis, we think it is important for surgeons to apply the following five technical principles: the proper-sized pedicle screw has to be inserted on the first attempt; repeated manipulation in setting instruments must be avoided; anterior penetration of the screw into the sacrum and insertion of two screws in each side are advocated for fixing the lumbosacral junction; industrious and detailed decortication of the posterior elements must be developed fully; and the use of autologous bone graft is recommended. 4. Acquisition of data: Sankey. Eur Spine J. 8600 Rockville Pike 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. Each side was judged separately. National Library of Medicine Gertzbein SD, Robbins SE: Accuracy of pedicular screw placement in vivo. EOS System Courtesy of EOS imaging. There were two complete degenerations of the upper disc, one central canal stenosis, and two asymptomatic disc space narrowings and retrolistheses. Pullout performance comparison of pedicle screws based on cement application and design parameters Tolga Tolunay, Cemile Bagl, Teyfik Demir, Mesut E Yaman, and Arslan K Arslan Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 2015 229: 11 , 786-793 Download Citation