Moffatt-Bruce SD, Ferdinand FD, Fann JI. Also notable, only one claim reported the use of intraoperative CT and was ultimately ruled in favor of the defendant. Rynecki ND, Coban D, Gantz O, et al. 18. 6. 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. Legal liability in iatrogenic orbital injury. West III JL, Bradford DS, Ogilvie JW: Results of spinal arthrodesis with pedicle screw-plate fixation. Aigner R, Bichlmaier C, Oberkircher L, Knauf T, Knig A, Lechler P, Ruchholtz S, Frink M. BMC Musculoskelet Disord. The last two patients had a T12L1 fracture-dislocation and a L4L5 spondylolytic spondylolisthesis at the site of plug dislodgments. To evaluate the accuracy of pedicle screw placement using a novel classification system to determine potentially significant screw misplacement. J Bone Joint Surg 61A:201207, 1979. 2006;65(4):416421. General complications were considered those developing during and after surgery that were not directly related to instrumentation. 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. Li HM, Zhang RJ, Shen CL. Elsamadicy AA, Sergesketter AR, Frakes MD, Lad SP. Spine 13:10121018, 1988. Preparation. 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. A total of 69 patients (mean age, 67.416 . Med Econ. Importantly, these advanced technologies are not always readily available or the standard of care and cannot supplant a thorough understanding of operative anatomy, a high-quality surgical technique, and general complication-avoidance measures. Lehmann TR, LaRocca HS: Repeat lumbar surgery: A review of patients with failure from previous lumbar surgery treated with spinal canal exploration and lumbar spine fusion. Hecht N, Kamphuis M, Czabanka M, et al. 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. Spine 6:615619, 1981. Spine 17:834837, 1992. Amount awarded to plaintiffs by US region, adjusted for inflation as of April 2020. 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. 2021 Nov 26;22(1):986. doi: 10.1186/s12891-021-04860-y. All case demographics are summarized in Table 1. Screws were divided into four categories: screws at risk (SAR), indeterminate misplacements (IMP), benign misplacements (BMP), accurately placed (AP). 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. 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). Stauffer RN, Coventry MB: Posterolateral lumbar-spine fusion: Analysis of the Mayo clinic series. I won't be at the office but I will check my voice mail. The medicolegal landscape of spine surgery: how do surgeons fare? Methods: 1 Although this technique has advantages over open instrumentation, it also presents new challenges and specific complications. 28. Malpractice claims in spine surgery in Germany: a 5-year analysis.
Accuracy of C2 pedicle screw placement using the anatomic freehand Svider PF, Husain Q, Kovalerchik O, et al. Nottmeier EW, Seemer W, Young PM. Thankfully, most screws are just misplaced by a millimeter or two out the front or are slightly off medially, so they are not doing real damage. The cost of defensive medicine on 3 hospital medicine services.
Patient Suffers Permanent Nerve Damage From Spinal Surgery Edmunds I, Cummine J, Fearnside M: Prevention of dislodgement of Cotrel-Dubousset rods from tulip screws. The third patient, who had central spinal stenosis, was treated by decompression alone. Of the 112 patients, 57 patients had a lumbar degenerative disorder, (lumbar degenerative spinal canal stenosis in 23 patients, degenerative or spondylolytic spondylolisthesis in 12 patients, postlaminectomy instability or stenosis in 20 patients, and recurrent disc prolapse in two patients), 42 patients had spinal cord injury, eight patients had infection, and five patients had a spinal tumor (Table 1). 2013;32(1):111119. 0 attorneys agreed. Malpractice liability and defensive medicine: a national survey of neurosurgeons. 16. 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 . 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 Unfortunately, the plaintiffs attorney was unable to offer an alternative theory of surgical negligence that would refute the defendants explanation. Forty-seven general complications were seen in 41 patients (36.5%). Pedicle screw placement is a common procedure. Routine CT scans were taken in all patients. The site is secure. INCLUDE WHEN CITING DOI: 10.3171/2020.8.FOCUS20600. Both issues represent the most frequent and highest payouts in spine malpractice claims.10,14,22 While several studies have explored many of the factors related to malpractice claims in spine surgery, the medicolegal impact of misplaced pedicle and/or lateral mass screws has not been directly reported in the literature. Johnston II CE, Ashman RB, Baird AM, Allard RN: Effect of spinal construct stiffness on early fusion mass incorporation: Experimental study. Larson AN, Santos ER, Polly DW Jr, Ledonio CG, Sembrano JN, Mielke CH, Guidera KJ. In situ spine arthrodesis permits load sharing by the vertebral bodies, preventing fatigue failure of the implant. Bookshelf Please do not include any confidential or sensitive information in a contact form, text message, or voicemail. Jury awards $4.5M over misplaced pedicle screw during spine surgery: 5 things to know Spine Monday, May 7th, 2018 Post Listen Text Size On April 6, a Union County, N.J., jury awarded a plaintiff $4.5 million over a botched spine surgery. HHS Vulnerability Disclosure, Help It should be used by experienced and qualified surgeons who are aware of the pitfalls associated with its use. The contact form sends information by non-encrypted email, which is not secure. 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. Per-patient analysis showed 23 (18.11%) of patients had all screws AP. 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. Rajasekaran S, Bhushan M, Aiyer S, et al. Screw Malposition: Are There Long-term Repercussions to Malposition of Pedicle Screws? 2017;31(3):287288. Determining legal responsibility in otolaryngology: a review of 44 trials since 2008. 29. Methods. Epstein NE. One common area for the potential avoidance of malpractice claims and subsequent payouts involves misplaced pedicle and/or lateral mass instrumentation. On April 6, a Union County, N.J., jury awarded a plaintiff $4.5 million over a botched spine surgery.
Complications and Problems Related to Pedicle Screw Fixation - LWW pedicle screw misplacement malpractice Level of evidence:
Jury awards $4.5M over misplaced pedicle screw during spine surgery: 5 Smith TR, Hulou MM, Yan SC, et al. The standard imaging technique for pedicle screw insertion is two-dimensional images obtained from C-arm-type X-ray fluoroscopy. J Bone Joint Surg 62A:13021307, 1980.
Mississippi Appellate Court Affirms Medical Malpractice Defense Verdict 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. Median screw misplacement rate was 10% in group A and 13% in group B. 21. 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. Scarone P, Vincenzo G, Distefano D, et al. 20th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference, 8th Annual Health IT + Digital Health + RCM Conference, 29th Annual Meeting - The Business & Operations of ASCs, The issues spine surgeons are advocating for outside of the operating room, Centinel Spine is now covered by all major payers, What's next for SI joint fusion? Pediatric pedicle screw placement using intraoperative computed tomography and 3-dimensional image-guided navigation. L3S1 spine arthrodesis was done in the first patient but the correction of scoliosis was not sufficient and coronal imbalance persisted after surgery, which accelerated the degeneration of the level just above the arthrodesis. Moreover, several cases stated that the surgeon used only the anteroposterior or the lateral view, but not both, and the plaintiffs counsel used this information in support of their claim. Dr. Abd-El-Barr is a consultant for Spineology. 2012;21(suppl 2):S196S199. These risks can be minimized by the judicious use of instrumentation by experienced surgeons for specific indications as supported by the literature. In two patients in the current series, dislodgement of the rods from tulip screws occurred, as reported originally by Edmunds et al. Complications were classified as general, hardware-related, problems associated with the instrumented segments, junctional level problems, and problems related with balance (Table 2). These complications may have resulted from powerful bending movement acting on the screw at its entry point to the bone. After the removal of duplicates, a total of 68 unique cases met our inclusion criteria and were included for analysis. The screws were needed to stabilize the spine and fix the fused vertebrae in place. 8,24,25,32.
Risk Factors for the Drift Phenomenon in Oarm NavigationAssisted However, the misplacement of pedicle screws can lead to disastrous complications. 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. J Am Coll Surg. 7. In their meta-analysis of nine randomized controlled trials, Li et al. 11. 37. Pedicle screw insertions are commonly used for posterior fixation to treat various spine disorders, deformities, and trauma. Acquisition of data: Sankey. Figure 1: Lower thoracic pedicles provide the firm purchase of the pedicle screw from a lateral starting point and 10-15 degrees convergent angle Surgical technique "Free Hand" pedicle screw placement [50] Our "Free Hand" technique is equivalent for lumbar and 2011;365(7):629636. Several studies have shown that spine surgery is at the highest risk for litigation among the surgical subspecialties.12,29 The majority of claims are related to technical and procedural errors,29 including misplaced pedicle and/or lateral mass screws. 20. In patients with degenerative conditions, all of the affected segments were included in the instrumentation and each vertebra was fixed with two pedicle screws. Neurosurgical practice liability: relative risk by procedure type. Eur Spine J. 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. The rod is held in place by "pedicle screws," which the surgeon must insert into the pedicles. However, the medicolegal impact of misplaced screws on spine surgery has not been directly reported in the literature. Unable to load your collection due to an error, Unable to load your delegates due to an error. 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. Dalenberg DD, Asher MA, Robinson RG, Jayaraman G: The effect of a stiff spinal implant and its loosening on bone mineral content in canines.
Pedicle screw replacement in spinal surgery - The MDU