pedicle screw misplacement malpractice

N Engl J Med. 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. 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. 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). Neurosurgical practice liability: relative risk by procedure type. A total of 2724 screws were placed in 127 patients. What can spine surgeons do to improve patient care and avoid medical negligence suits? 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. 2005;293(21):26092617. A large number of studies have reported that in conventional thoracolumbar surgery, compared with traditional freehand screw placement, the accuracy of intraoperative pedicle screw placement has been improved with O-arm intraoperative navigation technology. Spine 6:615619, 1981. Malpractice issues in neurological surgery. official website and that any information you provide is encrypted + 48 696 042 504. Ultimately, additional prospective, multiinstitutional large-volume studies are needed to validate these findings, and future studies should evaluate the long-term impact on the routine use of intraoperative imaging confirmation and/or computer- or robot-assisted navigation on the frequency and success of malpractice claims related to misplaced pedicle and lateral mass screws. 2014;174(11):18671868. The development of the transpedicle screw has provided control of the vertebral motion segment in each plane, resisting any type of load. Lorenz M, Zindrick M, Schwaegler P, et al: A comparison of single level fusion with and without hardware. Can Postoperative Radiographs Accurately Identify Screw Misplacements? It is easier to confuse a jury than convince a judge: the crisis in medical malpractice. 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. 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. 2013;32(1):111119. 2019;19(7):12211231. Rothberg MB, Class J, Bishop TF, et al. 34. There were 74 men and 38 women, with a mean age of 47 years (range, 1872 years). Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina; and, Malpractice liability and defensive medicine: a national survey of neurosurgeons, Defensive medicine among high-risk specialist physicians in a volatile malpractice environment, Defensive medicine: a culprit in spiking healthcare costs, Incidence and costs of defensive medicine among orthopedic surgeons in the United States: a national survey study, Defensive medicine in U.S. spine neurosurgery, Personal consequences of malpractice lawsuits on American surgeons. 15. 2018;28(2):186193. Except for two patients with spinal metastatic disease, all other patients received an iliac crest autologous bone grafts. The initial search using the terms above returned 3654 cases. Harrington and Tullos 11 first reported the technique of transpedicle screw fixation, and Roy-Camille et al 23 popularized the first practical method of pedicle screw fixation. Results: A total of 2724 screws were placed in 127 patients. 13. Excessive hemorrhage occurred in two patients (1.8%) with coagulation disorders. Spine 24:23522357, 1999. pedicle screw: A rigid surgical implant used to stabilize adjacent spinal segments in spinal fusion surgery. Conclusion: Pedicle screw insertions are commonly used for posterior fixation to treat various spine disorders, deformities, and trauma. Rajasekaran S, Bhushan M, Aiyer S, et al. INCLUDE WHEN CITING DOI: 10.3171/2020.8.FOCUS20600. These complications may have resulted from powerful bending movement acting on the screw at its entry point to the bone. Epub 2021 Aug 28. 2017 Mar;5(2):109-116. doi: 10.1016/j.jspd.2016.10.007. Junctional problems were recorded as pathologic changes of the adjacent motion segments, just above and below the instrumented and fused segments. The contact form sends information by non-encrypted email, which is not secure. The rate of medical complications was 8%. 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. However, the misplacement of pedicle screws can lead to disastrous complications. 4). J Neurosurg Spine. 2013;34(6):699705. And while the jury debated for about two hours, at the end of its deliberation it sided with the defendants and entered a not guilty verdict. 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. 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. Rovit RL, Simon AS, Drew J, 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). 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. 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. 2018;83(5):9971006. The link was not copied. Epstein NE. Nayar G, Blizzard DJ, Wang TY, et al. 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. 2016;102(2):358362. 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. 20. $ = US$. Three slender patients complained of soft tissue irritation and a bothersome prominence because of the screws bulky profile. 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. Study supervision: Goodwin, Karikari, Shaffrey, Abd-El-Barr, KD Than. Spine J. J Bone Joint Surg 61A:201207, 1979. Author links open overlay panel Mohamad Bydon a b 1, Dimitrios Mathios a b 1, Mohamed Macki a b, Rafael De la Garza-Ramos a b, Nafi Aygun c, Daniel M. Sciubba a, Timothy F. Witham a, Ziya L. Gokaslan a b, Ali Bydon a b, Jean-Paul Wolinksy a. Through the use of expert witness testimony, Mr. da Costa was able to prove to the jury that by misplacing the pedicle screw during the surgery, and failing to timely diagnose and correct the malpositioned screw, Defendants deviated from accepted standards of care. 2022 Jun;8(2):234-241. doi: 10.21037/jss-22-28. Under the high-low agreement, Drs. Submitting a contact form, sending a text message, making a phone call, or leaving a voicemail does not create an attorney-client relationship. Harris RI, Wiley JJ: Acquired spondylolysis as a sequel to spine fusion. 2020;162(6):13791387. Segal J. However, following the spinal fusion, Nyquist began to experience foot drop in her right foot. Don't jump in get legal help. Spine 6:263267, 1981. 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. Rev Chir Orthop Reparatrice Appar Mot 62:151160, 1976. 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. Re: malpositioned pedicle screw resulting in additional surgery and disability. Among the plaintiff-awarded cases, 13 (61.9%) were decided by jury trial, 7 (33.3%) by settlement, and 1 (4.8%) by arbitration. 2011;24(1):1519. The last two patients had a T12L1 fracture-dislocation and a L4L5 spondylolytic spondylolisthesis at the site of plug dislodgments. Examples of both laterally and medially misplaced lumbar pedicle screws are provided in Fig. Presse Med 78:14471448, 1970. J Bone Joint Surg 45A:11591170, 1963. demonstrated that the number of hospital discharges for spinal fusion increased 2.4 times (137%) from 174,223 to 413,171 (p < 0.001) between 1998 and 2008.32 The true frequency of malpositioned pedicle and lateral mass screws is likely underestimated in spine surgery given the fact that the majority of misplaced screws, as well as the potential complications related to them, are not reported in practice and may be clinically silent. Once the spine is exposed, the appropriate levels of fixation are confirmed with the image intensifier. Am J Orthop. Surg Neurol Int. Pedicle screws are used by spine surgeons as part of a fusion in which two adjacent bones in the spine are combined together as one. In patients with degenerative conditions, all of the affected segments were included in the instrumentation and each vertebra was fixed with two pedicle screws. 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. The accuracy rate of pedicle screw (PS) placement varies from 85% to 95% in the literature. Privacy Policy. 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). The cost of defensive medicine on 3 hospital medicine services. 2014 Sep;21(3):320-8. doi: 10.3171/2014.5.SPINE13567. Per-patient analysis reveals more concerning numbers toward screw misplacement. Med Econ. matte black square deadbolt; roberts point park fishing report; qr code on binax covid test; mff premium character list. Two patients with associated injuries in the lower limbs had deep venous thrombosis develop, three patients had pneumonia develop, and four patients with neurologic impairment had urinary tract infections develop. Clipboard, Search History, and several other advanced features are temporarily unavailable. Agarwal N, Gupta R, Agarwal P, et al. Comparetto, Esq., 727-328-7900, www.florida-malpractice-lawyers.com. Friedlander and Bradley will pay half of the $2.25 million. Malpractice claims in spine surgery in Germany: a 5-year analysis. concluded that the robot-assisted technique was significantly more accurate than the traditional freehand technique.39 Despite the learning curve and initial cost of obtaining technologies such as 3D fluoroscopic devices, intraoperative CT, or robotic navigational systems, the routine use of these technologies for intraoperative imaging confirmation and potential revision of misplaced screws may help spine surgeons avoid inadvertent iatrogenic morbidity for their patients and potential litigation.

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