pedicle screw misplacement malpractice

In addition, seven (6.3%) dural tears occurred during the decompression and none occurred during instrumentation. This step in implant evolution was inevitable, because prior phases of implant development did not control each plane of motion segment stress. Spine 16(8 Suppl):S422427, 1991. Harrington PR, Tullos HS: Reduction of severe spondylolisthesis in children. Epub 2021 Aug 28. 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. Scarone P, Vincenzo G, Distefano D, et al. Safety and efficacy of pedicle screw placement using intraoperative computed tomography: consecutive series of 1148 pedicle screws. Pitfall: Unstable injuries. 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. Dr. K. D. Than is a consultant for Bioventus and receives honoraria from DJO and LifeNet Health. 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. Spine 19:25842589, 1994. Privacy Policy. government site. Defendant-awarded cases by US region (right). Spine 13:10121018, 1988. All the operations were done by one surgeon (PK). It is indicated that screws medially misplaced at a distance greater than 2-mm, especially 4 mm, may be a cause of negative effects on the neural structure and should be removed during the early phase of the postoperative period, even among patients without postoperative neurological abnormalities. Methods. Spine 16:576579, 1991. (PDF) Lumbosacral pedicle screw placement using a fluoroscopic pedicle The screws were needed to stabilize the spine and fix the fused vertebrae in place. Epstein NE. The radiology results showed that the surgical screw placed at the right L4-5 area had breached the medial wall and was actually extending into the spinal canal. In patients with degenerative conditions, all of the affected segments were included in the instrumentation and each vertebra was fixed with two pedicle screws. Retrospective Computed Tomography Scan Analysis of Percutaneously (PDF) Accuracy of pedicle screw placement in the lumbosacral spine JAMA. Spine 15:908912, 1990. 2018;27(9):23392347. Neurosurgery. However, the medicolegal impact of misplaced screws on spine surgery has not been directly reported in the literature. Spine (Phila Pa 1976). Pedicle screw insertion techniques: an update and review of the 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. pedicle screw misplacement malpractice. As compared to cases in 19952009, those in 20102019 resulted in a significantly higher average nominal payout to plaintiffs ($776,439 $74,460 vs $1,506,000 $385,527, p = 0.028). Critically revising the article: all authors. 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. 5. Potential complications may include increased pain, infection, or mechanical . J Bone Joint Surg 62A:13021307, 1980. 3). 24. Jury awards $4.5M over misplaced pedicle screw during spine surgery: 5 J Bone Joint Surg 45A:11591170, 1963. Hadjipavlou A, Enker P, Dupuis P, Katzman S, Silver J: The causes of failure of lumbar transpedicular spinal instrumentation and fusion: A prospective study. The largest inflation-adjusted payout awarded to the plaintiff ($3,372,185) for nerve root injury occurred in a 36-year-old male who had undergone an L4S1 posterior spinal fusion, which resulted in permanent and direct injury to right L5 and S1 nerve roots, with foot drop and radiculopathy. 2006;65(4):416421. 26. The plaintiff underwent revision surgery in May 2013. 17,18,31,39 Edwards 6 showed that solid arthrodesis developed in 96% of patients without previous surgery, whereas 84% of patients having secondary operations experienced a similar result. 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). The accuracy rate of pedicle screw (PS) placement varies from 85% to 95% in the literature. Melissa Nyquist required a lumbar back fusion for a herniated disc at the L4-5 level. 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. 2019;19(7):12211231. Percentage of cases per US region (center). The majority of plaintiffs were male (n = 44, 64.7%), and the median age among all cases was 46 years (range 3757 years). The remaining two patients had asymptomatic junctional problems develop after two- and three-segment fusions, at the third and fourth postoperative year, respectively. 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. 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). Three slender patients complained of soft tissue irritation and a bothersome prominence because of the screws bulky profile. 28. Plaintiff-awarded cases by US region (left). Error in trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults, Spinal fusion in the United States: analysis of trends from 1998 to 2008, Safety and efficacy of pedicle screw placement using intraoperative computed tomography: consecutive series of 1148 pedicle screws, The accuracy of pedicle screw placement using intraoperative image guidance systems, Accuracy of pedicle screw insertion by AIRO, intraoperative CT in complex spinal deformity assessed by a new classification based on technical complexity of screw insertion, 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, Use of the Airo mobile intraoperative CT system versus the O-arm for transpedicular screw fixation in the thoracic and lumbar spine: a retrospective cohort study of 263 patients, Accuracy and workflow of navigated spinal instrumentation with the mobile AIRO, Accuracy of pedicle screw placement and clinical outcomes of robot-assisted technique versus conventional freehand technique in spine surgery from nine randomized controlled trials: a meta-analysis, Safety and accuracy of robot-assisted versus fluoroscopy-guided pedicle screw insertion for degenerative diseases of the lumbar spine: a matched cohort comparison, Verdict/Settlement Search and Inclusion/Exclusion Criteria, Plaintiff Claim and Index Surgery Information, Impact of Medical Malpractice on Neurosurgeon and Orthopedic Surgeon Careers, Financial Burden of Medical Malpractice Claims Related to Misplaced Pedicle and/or Lateral Mass Screws, Frequency of Misplaced Pedicle and Lateral Mass Screws in Spine Surgery, Strategies to Improve the Accuracy of Screw Placement in Spine Surgery, Top 25 Cited Gamma Knife Surgery Articles - Trigeminal Neuralgia, Top 25 Cited Gamma Knife Surgery Articles - Volume 111, https://doi.org/10.3171/2020.8.FOCUS20600, https://www.bls.gov/data/inflation_calculator.htm, Volume 49 (2020): Issue 5 (Nov 2020): Medicolegal issues in neurosurgery, Single vs multiple misplaced screw(s), no. Acta Neurochir (Wien). Problems in the instrumented segments were considered those occurring from narrowing of the disc space greater than 3 mm, pseudarthrosis, and loss of reduction. You are talking one of the most complicated area of the law. It has a great developing technique that is used for fixation and fusion in spine surgery. Previous biomechanical and clinical studies defining junctional segment problems are lacking and consist mainly of case reports. Malpractice claims in spine surgery in Germany: a 5-year analysis. * 1. Defensive medicine in U.S. spine neurosurgery. 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. Mason A, Paulsen R, Babuska JM, et al. Neurosurgical experience with malpractice litigation: an analysis of closed claims against neurosurgeons in New York State, 1999 through 2003. Ahmadi SA, Sadat H, Scheufler KM, et al. Spine surgery has been disproportionately impacted by medical liability and malpractice litigation, with the majority of claims and payouts related to procedural error. 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. Rajasekaran S, Bhushan M, Aiyer S, et al. 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. Spine surgery has been disproportionately impacted by medical liability and malpractice litigation, with the majority of claims and payouts related to procedural error. Study design: The patient suffered permanent nerve damage as a result of the puncture. Pullout performance comparison of pedicle screws based on cement 2011;24(1):1519. JAMA. 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. Spine 19(20 Suppl):2279S2296, 1994. Malpractice litigation and the spine: the NHS perspective on 235 successful claims in England. The https:// ensures that you are connecting to the 18. A total of 247 screws (9.07%) were BMP, 52 (1.91%) were IMP, and 29 (1.06%) were considered SAR. The third patient, who had central spinal stenosis, was treated by decompression alone. Katonis PG, Kontakis GM, Loupasis GA, et al: Treatment of unstable thoracolumbar and lumbar spine injuries using Cotrel-Dubousset instrumentation. We avoid using sharp automated drilling, and probe fully the pedicle cavity to prevent nerve root impairment. 2020;11:38. 10. 5. Pedicle screw insertion in the thoracolumbar spine. 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. Adjusted for age and preoperative Cobb angle, patients with a higher misplacement rate were more likely to have screws . I won't be at the office but I will check my voice mail. A rod is used to hold the vertebra together to allow fusion to occur. Feb. 16, 2021 Accurate placement of pedicle screws is key to avoiding the potential complications of spinal fusion surgery and improving overall spinal fixation. It is an effective procedure in that it provides an almost immediate stabilization of the spine [ 2-5 ]. Conception and design: Sankey, KD Than. Robotic-assisted pedicle screw placement fails to reduce overall Studies have shown that the greatest proportion of malpractice claims in spine surgery are related to procedural error,10,11,14,16,17,19 often resulting in the highest payouts.11,20 For spine surgery, one common area for the potential avoidance of malpractice claims and subsequent payouts involves misplaced pedicle and/or lateral mass screws, which occurs in approximately 14%55% of cases using standard techniques and results in neurological injury and/or durotomy in approximately 1%8% of cases.21 Misplaced screws have the potential to cause severe and sometimes permanent neurological deficits, including spinal cord and/or nerve root injury,21 as well as to decrease the stability of the fusion construct, leading to delayed complications related to pseudarthrosis. J Neurosurg Spine. Likewise, cases are uploaded on a voluntary basis by state and federal judges and courts, which may lead to selection bias.

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