pedicle screw misplacement malpractice

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). 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. Please try again soon. One common area for the potential avoidance of malpractice claims and subsequent payouts involves misplaced pedicle and/or lateral mass instrumentation. Once the spine is exposed, the appropriate levels of fixation are confirmed with the image intensifier. The median time to case closure was longer for defendant-awarded cases, but this finding was not statistically significant (61.5 vs 56.3 months, p > 0.05). J Bone Joint Surg 73A:11791184, 1991. Linking and Reprinting Policy. Achieving proper lumbar lordosis, evaluating any preexisting scoliosis, and intraoperative assessment with AP radiographs could prevent balance problems. At the lumbosacral area, breakage of a divergent screw of a Chopin block occurred on only one side with no loss of correction. In six patients (5.3%) with degenerative spine disease, the disc material had been removed. Among the plaintiff-awarded cases, 13 (61.9%) were decided by jury trial, 7 (33.3%) by settlement, and 1 (4.8%) by arbitration. Complete degeneration of the upper disc developed in two patients who had spinal stenosis and degenerative scoliosis. PURPOSE This study aimed to compare rates of perioperative complications between robotic-assisted and conventional . Unfortunately, the plaintiffs attorney was unable to offer an alternative theory of surgical negligence that would refute the defendants explanation. 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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. Spine surgery has been disproportionately impacted by medical liability and malpractice litigation, with the majority of claims and payouts related to procedural error. Elizabeth Hofheinz, M.P.H., M.Ed. Screws were divided into four categories: screws at risk (SAR), indeterminate misplacements (IMP), benign misplacements (BMP), accurately placed (AP). Clin Orthop 203:717, 1986. Defensive medicine in U.S. spine neurosurgery. Junctional problems were recorded as pathologic changes of the adjacent motion segments, just above and below the instrumented and fused segments. 2017 Mar;5(2):109-116. doi: 10.1016/j.jspd.2016.10.007. Statistical analysis: Sankey. A retrospective review of closed medicolegal cases with verdicts or settlements between 1995 and 2019 was performed using the Westlaw Edge legal research database (Thomson Reuters).7,14,16,23,24 A search of closed federal and state malpractice claims within the Verdicts and Settlements section consisted of the following: spine and surgery and pedicle and screw and fusion and (misplaced or misguided or mispositioned) and surgeon. Inclusion criteria consisted of malpractice claims against surgeons for complications related to misplaced pedicle and/or lateral mass screws. A total of 2724 screws were placed in 127 patients. Several limitations should be carefully considered when interpreting our results. Dr. Abd-El-Barr is a consultant for Spineology. Hecht N, Kamphuis M, Czabanka M, et al. Accuracy of C2 pedicle screw placement using the anatomic freehand technique. Five patients had uneventful early postoperative course. 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. Lali Sekhon, Jocelyn Idema & more: 4 spine and neurosurgeons making headlines, Spinal cord stimulation trumps medication for pain reduction 7 takeaways, Dr. Khalid Kurtom on major trends in spinal cord injury surgery. 38. Instrumentation removal is an option for patients with successful arthrodesis, but remains controversial. A retrospective review of charts, x-rays (XRs) and computed tomography (CT) scans was performed. Risk Factors for the Drift Phenomenon in Oarm NavigationAssisted Spine surgery has been disproportionately impacted by medical liability and malpractice litigation, with the majority of claims and payouts related to procedural error. 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. Accuracy and workflow of navigated spinal instrumentation with the mobile AIRO CT scanner. Jury awards $4.5M over misplaced pedicle screw during spine surgery: 5 The majority of screws were misplaced in the lumbar spine for both plaintiff- and defendant-awarded cases (66.7% vs 57.4%, respectively, p = 0.564; Table 1). Reprint requests to Pavlos Katonis, MD, 99 Minoos & Thenon Street, 71305, Heraklion, Crete, Greece. Pedicle screw placement: Robotic assistance for greater precision 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. Examples of both laterally and medially misplaced lumbar pedicle screws are provided in Fig. Fager CA. Objective: 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. Placement of the pedicle screws in the thoracolumbar and lumbar spine is a technically demanding procedure. Characteristics of medicolegal cases related to misplaced screws in spine surgery. On average, physicians spend nearly 11 percent of their 40-year careers with an open, unresolved malpractice claim. Eur Spine J. Drs. 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. (A) Anteroposterior and (B) lateral radiographs taken 1 year after surgery show upper screw breakage in the application of a short Cotrel-Dubousset construct in a T12 burst fracture. Pedicle screw accuracy in thoracolumbar fractures- is routine General complications were considered those developing during and after surgery that were not directly related to instrumentation. The median time to case closure was 56.3 (35.267.2) months when ruled in favor of the plaintiff (i.e., patient) compared to 61.5 (51.477.2) months for defendant (surgeon) verdicts (p = 0.117). 9. George Sapkas, MD, DSc; and Panayiotis J. Papagelopoulis, MD, DScGuest Editors. Pedicle screw insertion - AO Foundation Epstein NE. Adjusted for age and preoperative Cobb angle, patients with a higher misplacement rate were more likely to have screws . 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. PMC Spinal fusion procedures are increasingly performed each year, with Deyo et al. single homes for sale in lehigh valley, pa Call me tomorrow. 2014 Sep;21(3):320-8. doi: 10.3171/2014.5.SPINE13567. 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. Bookshelf Elsamadicy AA, Sergesketter AR, Frakes MD, Lad SP. Percentage of cases per US region (center). 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 Clin Orthop 203:126134, 1986. Forty-seven general complications were seen in 41 patients (36.5%). The highly litigious environment within healthcare has resulted in a majority of physicians practicing defensive medicine,15 often leading to burnout6,7 and an exorbitant ethical and financial burden on medical and surgical care.7,8 In 2008, medical liability accounted for $55.6 billion, representing 2.4% of the United States (US) healthcare expenditures that year,5,7,9,10 and the pervasive practice of defensive medicine may cost up to $210 billion annually in the US.5 A similar trend has been observed in Europe.11, Neurosurgery is the specialty most frequently affected by lawsuits and the fear of litigation, both in the US and abroad,12 with spine surgery at the forefront.11,1317 As a result, spine surgeons are nearly three times more likely than nonspine surgeons to practice defensive medicine, defined as the avoidance of high-risk procedures and the provision of unnecessary services and assessments beyond what is clinically necessary in an effort to avoid litagation.5 The average time to judgment in a case is approximately 5.1, 5.0, and 3.4 years for defendant verdicts, plaintiff rulings, and settlements, respectively.7,15 As a result, physicians spend an average of 11% of their careers dealing with one or more open malpractice claims.18 Neurosurgeons are especially impacted, spending an average of 27.2% of their careers in an open lawsuit.10. Spine 14:472476, 1989. True accuracy of percutaneous pedicle screw placement in thoracic and Facebook Google Plus Youtube RSS Email. St Louis, CV Mosby 322327, 1987. Dr. K. D. Than is a consultant for Bioventus and receives honoraria from DJO and LifeNet Health. In the current study, the arthrodesis rate of 89.4% compares favorably with other previously reported series in the spinal literature, most of which use radiographic means to access the status of the spinal arthrodesis. Careers. I won't be at the office but I will check my voice mail. Are We Underestimating the Significance of Pedicle Screw Misplacement The third patient, who had central spinal stenosis, was treated by decompression alone. Koktekir E, Ceylan D, Tatarli N, Karabagli H, Recber F, Akdemir G. Spine J. Defensive medicine: a culprit in spiking healthcare costs. Please do not include any confidential or sensitive information in a contact form, text message, or voicemail. 19. A neurologic deficit developed in one patient (0.9%) who had partial bilateral drop feet after reduction of L4L5 spondylolisthesis. Med Econ. Reoperation for Misplaced Pedicle Screws: A Multicenter Retrospec 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 Several studies reveal that fusion rates increase when rigid internal fixation is used, 14,20,21,33,38 and that by using pedicle screws and plates or rods for stabilization, spinal arthrodesis can be limited to the disease segments. Lorenz M, Zindrick M, Schwaegler P, et al: A comparison of single level fusion with and without hardware. Pedicle screws have been used to treat spinal disorders, including those caused by spinal cancer, congenital anomalies, trauma, and chronic pain syndromes. We also investigated the effect of bone mineral density (BMD), diameter of pedicle screws, and the region of spine on the pullout strength of pedicle screws. and 17.1% of the patients included had at least one screw misplaced. Screw Malposition: Are There Long-term Repercussions to Malposition of Pedicle Screws? Per-patient analysis reveals more concerning numbers toward screw misplacement. In the other patient, L4L5 float arthrodesis was done. 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. Safety and efficacy of pedicle screw placement using intraoperative computed tomography: consecutive series of 1148 pedicle screws. 13 Whitecloud et al 35 reported 15% neurologic complications, 5% being caused by incorrect screw placement. Materials and Methods Sixty . Under this theory of liability, the plaintiff needed to not only establish that she had experienced foot drop, a fact that no one was disputing, but that it was caused by the defendants negligence. pedicle screw: A rigid surgical implant used to stabilize adjacent spinal segments in spinal fusion surgery. PLoS One. 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. Median screw misplacement rate was 10% in group A and 13% in group B. With pedicle shapes and sizes varying wildly in the scoliotic spine, misplacement of a screwas well as and under- or oversizingare real possibilities in spine surgery. INCLUDE WHEN CITING DOI: 10.3171/2020.8.FOCUS20600. 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. A total of 2396 screws were placed accurately (87.96%). Epub 2014 Apr 4. Am J Transl Res. Br J Neurosurg. Defendant-awarded cases by US region (right). Am J Otolaryngol. reported that 69.3% of neurosurgeons who responded to their survey saw every patient as a potential lawsuit.1. 2021 Jul 1;41(Suppl 1):S80-S86. (PDF) Accuracy of pedicle screw placement in the lumbosacral spine Spine (Phila Pa 1976). 2006;65(4):416421. The patient had to undergo a subsequent surgery to remove the pedicles. 4. This demonstrates technical ability but does not represent the impact of screw misplacement on individual patients. The instrumentation and bone graft were left in place in these patients (total infection rate, 2.7%). 3). The last two patients had a T12L1 fracture-dislocation and a L4L5 spondylolytic spondylolisthesis at the site of plug dislodgments. 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. Epstein NE. Spine J. J Bone Joint Surg 45A:11591170, 1963. Guillain A, Moncany AH, Hamel O, et al. The medical malpractice suit Ayala v. Friedlander, M.D., claimed that a March 2011 lumbar fusion surgery performed by neurosurgeon Marvin Friedlander, MD, and orthopedic spine surgeon Douglas Bradley, MD, strayed from the accepted standards of care because a pedicle screw was placed in the wrong location. 2017;42(3):177185. Results: A total of 2724 screws were placed in 127 patients. The case facts centered on a spinal surgery the 34 year-old plaintiff had undergone at Central DuPage Hospital. Mayo Clinic uses the latest robot-assisted technology when indicated to enhance surgical precision in these procedures. 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. Also notable, only one claim reported the use of intraoperative CT and was ultimately ruled in favor of the defendant. Medical malpractice litigation has made a significant impact on spine surgery, with many spine surgeons avoiding complex cases or practicing other defensive medicine tactics in an effort to avoid being sued.5 Moreover, the majority of neurosurgeons spend more than 10% of their annual revenue on malpractice insurance,1,14 and the excessive financial risk of litigation is even leading some insurers to no longer offer coverage to spine surgeons.19 A 2011 study in the New England Journal of Medicine found that 19.1% of neurosurgeons are named as a defendant in a malpractice suit each year (highest of any specialty).12 Moreover, 88% of physicians in high-risk specialties, like neurosurgery, are involved in a lawsuit by age 45, increasing to a concerning 99% by 65 years of age.12 Such litigation places a substantial financial, temporal, and emotional burden on physicians in high-risk specialties, with studies showing that up to 72% of neurosurgeons1 admitted that their fear of litigation significantly influenced their practice,25 with many avoiding high-risk patients altogether.1 Similarly, Nahed et al. 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. 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. Insuring spinal neurosurgery. 2018;27(9):23392347. Spine 19(20 Suppl):2279S2296, 1994. 2021 Nov;9(6):1541-1548. doi: 10.1007/s43390-021-00377-5. Dalenberg DD, Asher MA, Robinson RG, Jayaraman G: The effect of a stiff spinal implant and its loosening on bone mineral content in canines. Waddell G, Kummell EG, Lotto WN, et al: Failed lumbar disc surgery and repeat surgery following industrial injuries. One of the common means of doing so is to place a screw into each of two adjacent spinal bones (vertebrae), and then a rod between them. Johnston II CE, Ashman RB, Baird AM, Allard RN: Effect of spinal construct stiffness on early fusion mass incorporation: Experimental study. This patient recovered completely in 6 weeks. 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 .

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