Descriptive analysis of state and federal spine surgery malpractice litigation in the United States. This retrospective study analyzes the complications and the problems developed during and after pedicle screw fixation in patients with spinal disorders and trauma. (A) Anteroposterior and (B) lateral radiographs show coronal imbalance that developed 4 years after surgery in a 57-year-old woman with L3L4 float fusion. With increasing pedicle screw usage, the number of patients with misplaced screws will likely increase proportionally. One hundred twelve consecutive patients were entered into a retrospective study of instrumented thoracolumbar, lumbar, and lumbosacral spinal arthrodesis at our institution, between September 1994 and January 1999. The plaintiff will recover $2.25 million because of a high-low agreement the lawyers entered after closing arguments, the New Jersey Law Journal reports. 2022 Jun;8(2):234-241. doi: 10.21037/jss-22-28. However, 5-10% of those misplaced screws are cause for concern." "To rectify this, we must have access to imaging devices during the procedure. Thirty-five (27.56%) had IMP and 18 (14.17%) had SAR. Methods: We avoid using sharp automated drilling, and probe fully the pedicle cavity to prevent nerve root impairment. The pedicle screws judged as misplacement. a Medial minor perforation Pedicle screw placement: Robotic assistance for greater precision Pedicle Screw Insertion in Spondylitis Tuberculosis | ORR To investigate intraoperative reinsertion of percutaneous pedicle screw (PPS) with intraoperative CT-based navigation and to evaluate the rate of deviation of PPS at postoperative radiographic examination. Many technological advances have been made over the past several decades in an effort to improve the accuracy of screw placement in spine surgery.3436 For example, 3D fluoroscopybased image guidance has been shown to decrease the pedicle breach rate in several studies compared to the rate with 2D fluoroscopic guidance or the freehand technique, particularly in deformity and revision surgeries.21,34,36,37 CT guidance or intraoperative confirmation has also been shown to further improve the accuracy of pedicle screw placement,3638 with reported accuracy rates of 89%100% reported in the literature, depending on the authors breach criteria.35 However, it is important to note that the use of this technology is often accompanied by a lower threshold for intraoperative screw revision, sometimes leading to higher rates of replaced screws.33 Arguably, these improved trajectories may avoid iatrogenic neurological deficits due to prolonged nerve root compression or even improve the stability of the construct;34,37 however, prospective studies of long-term outcomes and rates of revision surgery remain sparse in the literature. Cookie Policy. Continued clinical experience with various pedicle screw implant systems has led to ongoing improvements in system design to minimize implant failure rates and to improve ease of system application. 2. 2014;75(6):609613. 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%). Open lumbar pedicle screw technique - Operative Neurosurgery States were then grouped by US region and case year by 5-year intervals. Spine 14:472476, 1989. Laryngoscope. All Rights Reserved. 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. There were nine instrumentation failures at the thoracolumbar area (seven patients), lumbar area (one patient), and lumbosacral area (one patient). Lumbosacral pedicle screw placement using a fluoroscopic pedicle axis Inaccurate pedicle screw placement is relatively common even when placement is performed under fluoroscopic control. All these problems were observed only just above the upper instrumentation level and all were observed in patients older than 55 years. The jury found the defendants liable and allocated 75 percent of the fault to Dr. Friedlander and 25 percent to Dr. Bradley. Epub 2014 Jun 13. Accuracy of C2 pedicle screw placement using the anatomic freehand Feb. 16, 2021 Accurate placement of pedicle screws is key to avoiding the potential complications of spinal fusion surgery and improving overall spinal fixation. Sub-analysis of adolescent idiopathic scoliotic patients showed no curve or patient characteristic that correlated with IMP or SAR. Ultimately, additional prospective, multiinstitutional large-volume studies are needed to validate these findings, and future studies should evaluate the long-term impact on the routine use of intraoperative imaging confirmation and/or computer- or robot-assisted navigation on the frequency and success of malpractice claims related to misplaced pedicle and lateral mass screws. In unstable injuries, the segments above and below the level of injury may have a different orientation of the pedicle trajectory due to . Another possible cause was the high lateral torques to the entire frame that occurred during tightening of the tulip screw. 2018;43(14):984990. Neurological Outcome and Management of Pedicle Screws Misplaced Totally The screws were needed to stabilize the spine and fix the fused vertebrae in place. Clin Orthop 227:1023, 1988. 2013;34(6):699705. A neurologic deficit developed in one patient (0.9%) who had partial bilateral drop feet after reduction of L4L5 spondylolisthesis. On April 6, a Union County, N.J., jury awarded a plaintiff $4.5 million over a botched spine surgery. 38. The remaining eight patients, including two patients with spinal trauma, five patients with infection, and one patient with a tumor, had anterior and posterior procedures. Krag MH, Beynnon BD, Pope MH, et al: An internal fixator for posterior application to short segment of the thoracic, lumbar, or lumbosacral spine. Dr. Shaffrey has received grants from the NIH and Department of Defense. Sethi MK, Obremskey WT, Natividad H, et al. On average, physicians spend nearly 11 percent of their 40-year careers with an open, unresolved malpractice claim. The patient suffered permanent nerve damage as a result of the puncture. Thu, May 27th, 2021. 2012;89(10):7071. J Bone Joint Surg 61A:201207, 1979. 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. From the *Department of Orthopaedic Surgery, University of Crete Medical School, Heraklion, Greece; and the **First Department of Orthopaedics, University of Athens Medical School, Athens, Greece. Facebook Google Plus Youtube RSS Email. Zucherman J, Hsu K, Picetti III G, et al: Clinical efficacy of spinal instrumentation in lumbar degenerative disc disease. [] The accuracy for free-hand screw placement technique varies from 69% to 94%. Li HM, Zhang RJ, Shen CL. Although the rate of the reported complications was high, the final outcome of the patients was not affected significantly. 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. Retrospective Computed Tomography Scan Analysis of Percutaneously $2 Million Spinal Surgery Case Against Neurosurgeon and Hospital Malpractice issues in neurological surgery. The majority of plaintiffs were male (n = 44, 64.7%), and the median age among all cases was 46 years (range 3757 years). The site is secure. 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. Hardware problems were those related to the physical change of metal and screw position. Spine (Phila Pa 1976). 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. 4). Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. shooting in valdosta leaves one dead Methods. Pedicle screw instrumentation is widely used for the stabilization of the subaxial cervical, thoracic, and lumbar spine. It is an effective procedure in that it provides an almost immediate stabilization of the spine [ 2-5 ]. All the incidental dural tears were repaired immediately and produced no clinical sequelae. J Neurosurg. Each case was then carefully screened for relevance and sufficient data. Nyquist followed a medical malpractice lawsuit against Dr. Masnyk for his surgical error, alleging that the surgeon had improperly positioned the right L4 pedicel screw which had resulted in a nerve root injury and Nyquists subsequent foot drop. The literature gave a range of screw misplacement rates detected on postoperative imaging of between 1% and 18%, with the rate generally considered to be around 10%. 2012 Feb 1;37(3):E188-94. Jury awards $4.5M over misplaced pedicle screw during spine surgery: 5 The third patient, who had central spinal stenosis, was treated by decompression alone. Show more. Don't jump in get legal help. It should be used by experienced and qualified surgeons who are aware of the pitfalls associated with its use. Both of these patients complained of thigh pain but refused any additional surgery. Forty-seven general complications were seen in 41 patients (36.5%). Despite these failures, solid spinal arthrodesis was obtained in all patients. GraphPad Prism version 6.01 for Windows was used for all descriptive analyses (GraphPad Software). Mohar J, Vali M, Podovovnik E, Mihali R. Eur Spine J. A review of medicolegal malpractice suits involving cervical spine: what can we learn or change? 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. Int Orthop 20:3542, 1996. Clin Orthop 203:4553, 1986. In four of these patients, bent screws occurred at 8 to 10 months after surgery; in three patients, broken screw necks were seen 1 year after surgery and in two patients, tulip screw plug dislodgments were observed at 4 and 6 months postoperatively, respectively. 2018;28(2):186193. After the removal of duplicates, a total of 68 unique cases met our inclusion criteria and were included for analysis. I won't be at the office but I will check my voice mail. Routine CT scans were taken in all patients. $ = US$; MW = Midwest; NE = Northeast; SE = Southeast; SW = Southwest; W = West. 23. Misplacement of Pedicle Screws Leads to Years of Pain and Opioid Addiction Nationally Recognized Regionally Dominant Contact Us Now For a Free Consultation Over $850 Million in Verdicts and Settlements Home Articles Misplacement of Pedicle Screws Leads to Years of Pain and Opioid Addiction Johnston II CE, Ashman RB, Baird AM, Allard RN: Effect of spinal construct stiffness on early fusion mass incorporation: Experimental study. 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. 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). 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. Safety and efficacy of pedicle screw placement using intraoperative computed tomography: consecutive series of 1148 pedicle screws. 2012;21(suppl 2):S196S199. Please try after some time. The purpose of current study was to analyze the complications and problems during and after pedicle screw fixation for various spinal disorders and trauma. Spine 18:18621866, 1993. In White AH, Rothman RH, Ray CD (eds). Several limitations should be carefully considered when interpreting our results.
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