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Accessibility 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. 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. Scarone P, Vincenzo G, Distefano D, et al. Disclaimer. In patients with degenerative conditions, all of the affected segments were included in the instrumentation and each vertebra was fixed with two pedicle screws. This patient recovered completely in 6 weeks. First, this is a retrospective analysis of cases obtained from the web-based Westlaw Edge legal research database. Epub 2014 Apr 4. 15. The rate of medical complications was 8%. 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. Critically revising the article: all authors. Cerebrospinal fluid fistulas. government site. Studdert DM, Mello MM, Sage WM, et al. A total of 69 patients (mean age, 67.416 . 6 Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. 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. Friedlander and Bradley will pay half of the $2.25 million. Roy-Camille R, Roy-Camille M, Demeulenaere C: Osteosynthese du rachis dorsal, lombaire et lombo-sacre par plaque metalliques vissees dans les pedicules vertebraux et es apophyses articularies. 2011;24(1):1519. Each side was judged separately. SECTION I SYMPOSIUM: Advances in Spine Surgery, Distribution of Spinal Disorders in 112 Patients, Classification of Complications in 64 patients. Pedicle screw insertions are commonly used for posterior fixation to treat various spine disorders, deformities, and trauma. Screws penetrating the anterior cortex and abutting vascular structures, particularly aortic abutment with left-sided screws, which can lead to erosion and pseudoaneurysms. Excessive hemorrhage occurred in two patients (1.8%) with coagulation disorders. Seven hundred sixty-three screws were inserted in 138 patients. Lumbar Spine Surgery. Also notable, only one claim reported the use of intraoperative CT and was ultimately ruled in favor of the defendant. Personal consequences of malpractice lawsuits on American surgeons. Am J Otolaryngol. Amount awarded to plaintiffs by US region, adjusted for inflation as of April 2020. Spine arthrodesis was evaluated with plain AP and lateral radiographs taken 1 year after surgery. 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 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. 2012;37(1):6776. 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. Pedicle screw placement is a common procedure. Neurosurgery. 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. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. 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. Once the spine is exposed, the appropriate levels of fixation are confirmed with the image intensifier. Spine 13:10121018, 1988. 2017;42(3):177185. Bookshelf 2012;89(10):7071. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The defense pointed to the lack of evidence that the screw had ever come into contact with the L5 nerve root. 22. Retrospective analysis of reasons and revision strategy for failed thoracolumbar fracture surgery by posterior approach: a series of 31 cases. Epstein NE. 144 What can spine surgeons do to improve patient care and avoid medical negligence suits? Thu, May 27th, 2021. 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. Schlegel JD, Smith JA, Schleusener RN: Lumbar motion segment pathology adjacent to thoracolumbar, lumbar, and lumbosacral fusions. Ultimately, no significant differences in case demographics were found between plaintiff and defendant judgments (Table 1). J Pediatr Orthop. Although pedicle screw fixation opened a new horizon of spinal surgery by providing rigid fixation of the spine, it is a technically demanding procedure with potential complications including medical complications, hardware and technical problems, and long-term changes of junctional motion segments. Acquisition of data: Sankey. Facebook Google Plus Youtube RSS Email. 38. Spine 15:1114, 1990. Defensive medicine in U.S. spine neurosurgery. When adjusted for inflation, these values increased to $1,330,201 $882,023 versus $970,832 $381,619, respectively (p = 0.32; Fig. To prevent the development of pseudarthrosis, we think it is important for surgeons to apply the following five technical principles: the proper-sized pedicle screw has to be inserted on the first attempt; repeated manipulation in setting instruments must be avoided; anterior penetration of the screw into the sacrum and insertion of two screws in each side are advocated for fixing the lumbosacral junction; industrious and detailed decortication of the posterior elements must be developed fully; and the use of autologous bone graft is recommended. 2021 Jul 1;41(Suppl 1):S80-S86. Mukherjee S, Pringle C, Crocker M. A nine-year review of medicolegal claims in neurosurgery. A review of medicolegal malpractice suits involving cervical spine: what can we learn or change? 5. Please try after some time. To investigate intraoperative reinsertion of percutaneous pedicle screw (PPS) with intraoperative CT-based navigation and to evaluate the rate of deviation of PPS at postoperative radiographic examination. 4). Epstein NE. McAfee PC, Weiland DJ, Carlow JJ: Survivorship analysis of pedicle spinal instrumentation. Presse Med 78:14471448, 1970. It has a great developing technique that is used for fixation and fusion in spine surgery. Clin Orthop 203:7598, 1986. Safety and efficacy of pedicle screw placement using intraoperative computed tomography: consecutive series of 1148 pedicle screws. laterally placed screws and the azygous vein on the right (T5-T11). National Library of Medicine The contact form sends information by non-encrypted email, which is not secure. 34. 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. With increasing pedicle screw usage, the number of patients with misplaced screws will likely increase proportionally. J Neurosurg Spine. Malpractice issues in neurological surgery. All Rights Reserved. Hardware problems were those related to the physical change of metal and screw position. All the operations were done by one surgeon (PK). Agarwal N, Gupta R, Agarwal P, et al. J Neurosurg Spine. Luque ER: Segmental spinal instrumentation of lumbar spine. Rajaee SS, Bae HW, Kanim LE, Delamarter RB. 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. Patient safety: disclosure of medical errors and risk mitigation. Axial lumbar CT scans demonstrating both laterally (right) and medially (left) misplaced pedicle screws, resulting in pedicle and transverse process fractures (A) and canal compromise (A and B). 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. This step in implant evolution was inevitable, because prior phases of implant development did not control each plane of motion segment stress. 16. J Spinal Disord Tech. 2012;41(2):6973. Rovit RL, Simon AS, Drew J, et al. Spine 18:11601172, 1993. Spine 6:263267, 1981. 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. A misplacement rate of more than 20 % (129 misplaced screws out of 608) seems to be unacceptable compared to only 4.5 % misplacements when using CT-navigation leading to the conclusion that pedicle screw instrumentation in the middle and upper thoracic area should be carried out with the help of navigation only. Can Postoperative Radiographs Accurately Identify Screw Misplacements? Copyright 2023 Becker's Healthcare. Disclosures Dr. Karikari is a consultant for NuVasive, Globus, Johnson & Johnson, and DePuy and receives a spine fellowship fund from NuVasive. The link was not copied. 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. 2019;19(7):12211231. Twenty-one patients (18.8%) had thoracolumbar injuries, and loss of immediate postoperative deformity correction ranged from 1.4 to 4.5. Clipboard, Search History, and several other advanced features are temporarily unavailable. Spine fixation included one segment in 27 patients, two segments in 38 patients, three segments in 42 patients, and more than three segments in five patients. Moffatt-Bruce SD, Ferdinand FD, Fann JI. The case facts centered on a spinal surgery the 34 year-old plaintiff had undergone at Central DuPage Hospital. Two patients had an acute infection develop for which they required operative intervention with irrigation and debridement. Surg Neurol. Objective: 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). Review of neurosurgery medical professional liability claims in the United States. Both of these patients complained of thigh pain but refused any additional surgery. Screw Malposition: Are There Long-term Repercussions to Malposition of Pedicle Screws? Dr. K. D. Than is a consultant for Bioventus and receives honoraria from DJO and LifeNet Health. Saillant G: Etude anatomique des pedicules vertebraux: Application chirurgicale. Introduction. 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. [] Computer-assisted computed tomography (CT) techniques have improved the overall accuracy for pedicle screw placement, and has reduced complication rates. Misplaced pedicle and lateral mass screws result in a considerable risk of malpractice litigation against spine surgeons. Please enable scripts and reload this page. Privacy Policy. Pitfall: Unstable injuries. This study has shown that percutaneous insertion of pedicle screws in the lumbar spine is a safe and reliable technique, and despite the low misplacement rate of only 6.6%, it should be kept in mind that the surgical procedure is technically demanding and should be performed only by experienced spine surgeons. Whitecloud et al 35 reported an overall 45% rate of minor and major complications, with the rate of complications increasing to 63% in patients who had previous lumbar surgery. As part of the surgery, Dr. Taras Masnyk inserted four metal screws into the plaintiffs spine. 13. 2014;20(6):636643. In the other patient, L4L5 float arthrodesis was done. Int Orthop 20:3542, 1996. McLaughlin WM, Donnelley CA, Yu K, Gillinov SM, Tuason DA. There were no observed cases of screw misplacement outside the pedicle on routine AP and lateral radiographs. Litigation resulted in average payouts of $1,204,422 $753,832 between 1995 and 2019, when adjusted for inflation. Complications were classified as general, hardware-related, problems associated with the instrumented segments, junctional level problems, and problems related with balance (Table 2). 5. 3). N Engl J Med. Start; O firmie; Usugi; Serwis; Realizacje i porady; Kontakt A neurologic deficit developed in one patient (0.9%) who had partial bilateral drop feet after reduction of L4L5 spondylolisthesis. and transmitted securely. Erwin WD, Dickson JH, Harrington PR: Clinical review of patients with broken Harrington rods. 2. Hsu K, Zucherman JF, White AH: Internal Fixation With Pedicle Screws. 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. Additional survey data have shown that 50% of physicians exhibit at least a temporary loss of self-esteem after a malpractice claim, and at least 25% experience depression.22 As stated above, the average neurosurgeon spends 27.2% of his or her entire career in an open malpractice claim,10 and each case can take an average of 5.1, 5.0, and 3.4 years for defendant verdicts, plaintiff rulings, and settlements, respectively.7,15 Likewise, neurosurgeons have a higher risk than practitioners in other specialties of being named in multiple malpractice suits given the particularly high-risk nature of the specialty.10 Even when found in favor of the defendant (surgeon), each case ultimately takes a substantial emotional and financial toll on the physician(s) involved.