Among the plaintiff-awarded cases, 13 (61.9%) were decided by jury trial, 7 (33.3%) by settlement, and 1 (4.8%) by arbitration. 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. These numbers are in line with the current literature. The remaining two patients had asymptomatic junctional problems develop after two- and three-segment fusions, at the third and fourth postoperative year, respectively. J Bone Joint Surg 54A:11951204, 1972. GraphPad Prism version 6.01 for Windows was used for all descriptive analyses (GraphPad Software). None of these complications resulted in additional surgery or in a significant increase of morbidity. The standard imaging technique for pedicle screw insertion is two-dimensional images obtained from C-arm-type X-ray fluoroscopy. 6. Conception and design: Sankey, KD Than. The purpose of current study was to analyze the complications and problems during and after pedicle screw fixation for various spinal disorders and trauma. 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. 2016;124(5):15241530. Neurosurgical experience with malpractice litigation: an analysis of closed claims against neurosurgeons in New York State, 1999 through 2003. Pedicle screw insertions are commonly used for posterior fixation to treat various spine disorders, deformities, and trauma. Kreisman Law Offices has been handling Illinois surgical error lawsuits for individuals and families for more than 35 years in and around Chicago, Cook County and surrounding areas, including Batavia, Bellwood, Deerfield, Evanston, Franklin Park, and Lansing. Pedicle screws have been used to treat spinal disorders, including those caused by spinal cancer, congenital anomalies, trauma, and chronic pain syndromes. doi: 10.1097/BPO.0000000000001828. Epub 2014 Jun 13. Steffee AD, Biscup RS, Sitkowski DJ: Segmental spine plates with pedicle screw fixation: A new internal fixation device for disorders of the lumbar and thoracolumbar spine. It has a great developing technique that is used for fixation and fusion in spine surgery. Johnston II CE, Ashman RB, Baird AM, Allard RN: Effect of spinal construct stiffness on early fusion mass incorporation: Experimental study. 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. Judgment information associated with a defendant (surgeon) versus plaintiff (patient) ruling, trial versus settlement versus arbitration decision, award amount, and time to decision or case closure from index surgery was also recorded. General complications were considered those developing during and after surgery that were not directly related to instrumentation. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. 2022 Sep 15;14(9):6323-6331. eCollection 2022. All case demographics are summarized in Table 1. Hecht N, Kamphuis M, Czabanka M, et al. Neurosurgery. McLaughlin WM, Donnelley CA, Yu K, Gillinov SM, Tuason DA. This study quantifies the rate of screw misplacement on a per-patient basis to highlight its effect on potential morbidity. The rate of reoperation for screw misplacement per screw was 0.17%. Epstein NE. A p < 0.05 was considered statistically significant. J Bone Joint Surg 45A:11591170, 1963. An official website of the United States government. 2013;34(6):699705. Rovit RL, Simon AS, Drew J, et al. The authors of the current study aimed to describe this impact in the United States, as well as to suggest a potential method for mitigating the problem. 2017;31(3):287288. [] The accuracy for free-hand screw placement technique varies from 69% to 94%. Unilateral nonunion was seen in three patients (2.7%), associated with implant failure in one of the patients. PLoS One. Spine 18:23252326, 1993. Spine surgery has been disproportionately impacted by medical liability and malpractice litigation, with the majority of claims and payouts related to procedural error. 2022 Dec;31(12):3544-3550. doi: 10.1007/s00586-022-07427-0. This retrospective study analyzes the complications and the problems developed during and after pedicle screw fixation in patients with spinal disorders and trauma. 36. Screws penetrating the anterior cortex and abutting vascular structures, particularly aortic abutment with left-sided screws, which can lead to erosion and pseudoaneurysms. Screws were divided into four categories: screws at risk (SAR), indeterminate misplacements (IMP), benign misplacements (BMP), accurately placed (AP). Morphometric analysis of the proximal thoracic pedicles in Lenke II and IV adolescent idiopathic scoliosis: an evaluation of the feasibility for pedicle screw insertion. 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. Comparetto, Esq., 727-328-7900, www.florida-malpractice-lawyers.com. However, the impact of robotic-assisted spinal fusion on patient outcomes is less clear. 14. One hundred four of the 112 patients had a posterior procedure. 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. 2,24,28,36. 2011;306(10):1088. Spine 19:25842589, 1994. Screw Malposition: Are There Long-term Repercussions to Malposition of Pedicle Screws? The cost of defensive medicine on 3 hospital medicine services. Acquisition of data: Sankey. 144 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. Eur Spine J. All Rights Reserved. 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 West III JL, Bradford DS, Ogilvie JW: Results of spinal arthrodesis with pedicle screw-plate fixation. 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. 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. These complications may have resulted from powerful bending movement acting on the screw at its entry point to the bone. Taylor CL. Spine 6:263267, 1981. Risk factor analysis showed smaller Cobb angles increased likelihood of all screws being AP. J Neurosurg Spine. On April 6, a Union County, N.J., jury awarded a plaintiff $4.5 million over a botched spine surgery. 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. Mean amounts awarded SD to plaintiffs by jury trial (n = 13) versus settlement/arbitration (n = 7), adjusted for inflation as of April 2020. Instrumentation removal is an option for patients with successful arthrodesis, but remains controversial. 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. The medicolegal landscape of spine surgery: how do surgeons fare? The jury found the defendants liable and allocated 75 percent of the fault to Dr. Friedlander and 25 percent to Dr. Bradley. 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. 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. Determining legal responsibility in otolaryngology: a review of 44 trials since 2008. All Rights Reserved. The third surgical procedure removed the pedicle screws but left the patient in an unfused state with an unstable spine. 2005;293(21):26092617. 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. may email you for journal alerts and information, but is committed Presse Med 78:14471448, 1970. Spine 13:696706, 1988. Per-patient analysis reveals more concerning numbers toward screw misplacement. The .gov means its official. Spine arthrodesis was evaluated with plain AP and lateral radiographs taken 1 year after surgery. 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. Can Postoperative Radiographs Accurately Identify Screw Misplacements? 26 They support that after a lengthy symptom-free period, segments next to a fused segment can break down and the segment next to the adjacent segment is almost as likely to break down as the adjacent segment. 1 Although this technique has advantages over open instrumentation, it also presents new challenges and specific complications. J Neurosurg Spine. A Cotrel-Dubousset spinal system (Medtronic Sofamor Danek, Memphis, TN) was used in all patients and the total number of screws used was 658. 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. single homes for sale in lehigh valley, pa single homes for sale in lehigh valley, pa Home Realizacje i porady Bez kategorii single homes for sale in lehigh valley, pa The accuracy of pedicle screw placement using intraoperative image guidance systems. Pedicle screw insertions are commonly used for posterior fixation to treat various spine disorders. The average age of the patients was 47 years and the average followup was 35 months. Of note, the award amount for one settlement case was undisclosed. The total number of reoperations for MPS and patient clinical data were obtained from medical records at each hospital. (A) Anteroposterior and (B) lateral radiographs taken 2 years after surgery show unilateral pseudarthrosis in a 55-year-old man with spinal stenosis. 8,24,25,32. 27,30 Infected pseudarthrosis developed in one patient (0.9%) with an L4S1 arthrodesis, and the instrumentation was removed 18 months later resulting in a flat back syndrome.
pedicle screw misplacement malpractice
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