pedicle screw misplacement malpractice
Weinstein JN, Spratt KF, Spengler D, Brick C, Reid S: Spinal pedicle fixation: Reliability and validity of roentgenogram-based assessment and surgical factors on successful screw placement. 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. Dr. Friedlander did not order a CT or MRI until January 2013, when the pedicle screw was found to be in the wrong location and a failed fusion was diagnosed, according to the suit. Saillant G: Etude anatomique des pedicules vertebraux: Application chirurgicale. 2. Orthopedics. 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. Roy-Camille R, Saillant G, Mazel C: Internal fixation of the lumbar spine with pedicle screw plating. In five patients with thoracolumbar injuries, who were the first treated in the current series, and in four patients with fractures in the lower lumbar spine, two-segment fixation was used. Analysis and interpretation of data: Sankey, TT Than. While the majority of verdicts are found in favor of the defendant (surgeon), over 30% of cases in this study were found in favor of the plaintiff (patient), resulting in average inflation-adjusted payouts of over $1.2 million per claim over the past 25 years. Clin Orthop 284:8090, 1992. 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). Luque ER: Segmental spinal instrumentation of lumbar spine. Would you like email updates of new search results? Ultimately, no significant differences were seen in inflation-adjusted award information between plaintiff and defendant (Table 3). J Neurosurg Spine. Clin Orthop 203:717, 1986. 2016;102(2):358362. The link was not copied. Pedicle screw insertions are commonly used for posterior fixation to treat various spine disorders. J Pediatr Orthop. In the current study, only five patients with junction problems above the instrumented area were observed with the following probable predisposing factors: an already degenerative disc, coronal imbalance, very long arthrodesis, and old age. St Louis, CV Mosby 322327, 1987. Pedicle screws have been used to treat spinal disorders, including those caused by spinal cancer, congenital anomalies, trauma, and chronic pain syndromes. PLoS One. Erwin WD, Dickson JH, Harrington PR: Clinical review of patients with broken Harrington rods. In patients with degenerative conditions, all of the affected segments were included in the instrumentation and each vertebra was fixed with two pedicle screws. A.J. It is an effective procedure in that it provides an almost immediate stabilization of the spine [ 2-5 ]. Disclaimer. Epstein NE. Din RS, Yan SC, Cote DJ, et al. In six of these patients with injuries at the thoracolumbar area (four patients with bent screws and two patients with broken screws), the loss of correction ranged from 3 to 4.5 without change of anatomic reduction (Fig 1). 6 However, 5-10% of those misplaced screws are cause for concern." "To rectify this, we must have access to imaging devices during the procedure. Spine 18:23252326, 1993. 2013;123(9):20992103. JAMA. Administrative/technical/material support: Mehta, Wang, KD Than. 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. Can Postoperative Radiographs Accurately Identify Screw Misplacements? Feb. 16, 2021 Accurate placement of pedicle screws is key to avoiding the potential complications of spinal fusion surgery and improving overall spinal fixation. Methods: Malpractice liability and defensive medicine: a national survey of neurosurgeons. 2022 Sep 15;14(9):6323-6331. eCollection 2022. Nahed BV, Babu MA, Smith TR, Heary RF. matte black square deadbolt; roberts point park fishing report; qr code on binax covid test; mff premium character list. 1). 2012;37(1):6776. GraphPad Prism version 6.01 for Windows was used for all descriptive analyses (GraphPad Software). Dalenberg DD, Asher MA, Robinson RG, Jayaraman G: The effect of a stiff spinal implant and its loosening on bone mineral content in canines. Cotrel Y, Dubousset J, Guillaumat M: New universal instrumentation in spinal surgery. Five patients had uneventful early postoperative course. Except for two patients with spinal metastatic disease, all other patients received an iliac crest autologous bone grafts. The accuracy rate of pedicle screw (PS) placement varies from 85% to 95% in the literature. A review of medicolegal malpractice suits involving cervical spine: what can we learn or change? Epub 2014 Apr 4. Results: 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). and transmitted securely. J Bone Joint Surg 45A:11591170, 1963. With increasing pedicle screw usage, the number of patients with misplaced screws will likely increase proportionally. J Bone Joint Surg 73A:11791184, 1991. Show more. 2012;21(suppl 2):S196S199. Svider PF, Husain Q, Kovalerchik O, et al. 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Federal government websites often end in .gov or .mil. South Med J 62:17, 1969. Screws were divided into four categories: screws at risk (SAR), indeterminate misplacements (IMP), benign misplacements (BMP), accurately placed (AP). In unstable injuries, the segments above and below the level of injury may have a different orientation of the pedicle trajectory due to . 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). Spine 18:18621866, 1993. 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%. Spinal fusion procedures are increasingly performed each year, with Deyo et al. There were no observed cases of screw misplacement outside the pedicle on routine AP and lateral radiographs. Instrumentation removal is an option for patients with successful arthrodesis, but remains controversial. 2014;20(2):196203. Comparetto, Esq., 727-328-7900, www.florida-malpractice-lawyers.com. 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. Spine (Phila Pa 1976). Data is temporarily unavailable. The medicolegal landscape of spine surgery: how do surgeons fare? This occurred on only one side and the correction achieved by the instrumentation was maintained. Spine surgery has been disproportionately impacted by medical liability and malpractice litigation, with the majority of claims and payouts related to procedural error. 2014 Aug 1;14(8):1702-8. doi: 10.1016/j.spinee.2014.03.044. And while the offending screw was removed the next day, Nyquist continued to experience right foot drop, along with lower back pain and sciatica, i.e. 1. [] Computer-assisted computed tomography (CT) techniques have improved the overall accuracy for pedicle screw placement, and has reduced complication rates. Spine arthrodesis was evaluated with plain AP and lateral radiographs taken 1 year after surgery. Spine 15:908912, 1990. Neurologic injury. 2012 Feb 1;37(3):E188-94. Per-patient analysis reveals more concerning numbers toward screw misplacement. Deyo RA, Mirza SK, Martin BI. Similar to our findings, prior studies have shown that settlements result in lower payouts than cases that are ultimately taken to trial,7,14,15,30 with awards ranging from $125,000 to $9,000,000 compared to $134,000 to more than $38,000,000.7,15 Nevertheless, the true financial toll on spine surgery is largely unknown given that 85% of cases are dismissed or settled out of court, with undisclosed amounts.14 Likewise, substantial time is spent and costs, including legal and administrative, are incurred before judgment, as noted above. J Neurosurg Spine. J Spinal Disord Tech. The initial search using the terms above returned 3654 cases. 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. J Bone Joint Surg 54A:11951204, 1972. 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). 15. J Bone Joint Surg 61A:201207, 1979. 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. As part of the surgery, Dr. Taras Masnyk inserted four metal screws into the plaintiff's spine. Complications were classified as general, hardware-related, problems associated with the instrumented segments, junctional level problems, and problems related with balance (Table 2). 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. Likewise, cases are uploaded on a voluntary basis by state and federal judges and courts, which may lead to selection bias. 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. 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. 2007;106(6):11081114. 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. Daniels AH, Ruttiman R, Eltorai AEM, et al. This was followed by pseudarthrosis requiring revision surgery, present in 14.3% (n = 3) and 14.9% (n = 7) of plaintiff- and defendant-awarded cases, respectively (p = 0.99). . 2018;43(14):984990. 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. On April 6, a Union County, N.J., jury awarded a plaintiff $4.5 million over a botched spine surgery. Pedicle screw placement is a common procedure. Eur Spine J. Clin Orthop 203:4553, 1986. The patient had to undergo a subsequent surgery to remove the pedicles. Placement of thoracolumbar pedicle screws using three-dimensional image guidance: experience in a large patient cohort. 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. Presse Med 78:14471448, 1970. Hecht N, Kamphuis M, Czabanka M, et al. Spine 6:263267, 1981. Error in trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. Aigner R, Bichlmaier C, Oberkircher L, Knauf T, Knig A, Lechler P, Ruchholtz S, Frink M. BMC Musculoskelet Disord. Characteristics of medicolegal cases related to misplaced screws in spine surgery. Sethi MK, Obremskey WT, Natividad H, et al. Spine (Phila Pa 1976). may email you for journal alerts and information, but is committed Neurosurgeons and orthopedic surgeons were named as the defendant in an equal number of cases, and the decision for the plaintiff versus the defendant was also similar between specialties. 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. Spine 17:834837, 1992. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. Hsu K, Zucherman JF, White AH: Internal Fixation With Pedicle Screws. 4). 2018;18(2):209215. 22. Accuracy of C2 pedicle screw placement using the anatomic freehand technique. However, only a few complications were related to a poor clinical outcome. Percentage of cases per US region (center). Epub 2021 Aug 28. Misplaced pedicle and lateral mass screws result in a considerable risk of malpractice litigation against spine surgeons. Please do not include any confidential or sensitive information in a contact form, text message, or voicemail. 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. Pitfall: Unstable injuries.
