Another possible cause was the high lateral torques to the entire frame that occurred during tightening of the tulip screw. Neurosurgical experience with malpractice litigation: an analysis of closed claims against neurosurgeons in New York State, 1999 through 2003. 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. Facebook Google Plus Youtube RSS Email. 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. It is an effective procedure in that it provides an almost immediate stabilization of the spine [ 2-5 ]. Neurosurgical practice liability: relative risk by procedure type. Studies have shown that the greatest proportion of malpractice claims in spine surgery are related to procedural error,10,11,14,16,17,19 often resulting in the highest payouts.11,20 For spine surgery, one common area for the potential avoidance of malpractice claims and subsequent payouts involves misplaced pedicle and/or lateral mass screws, which occurs in approximately 14%55% of cases using standard techniques and results in neurological injury and/or durotomy in approximately 1%8% of cases.21 Misplaced screws have the potential to cause severe and sometimes permanent neurological deficits, including spinal cord and/or nerve root injury,21 as well as to decrease the stability of the fusion construct, leading to delayed complications related to pseudarthrosis. 2011;213(5):657667. 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. J Neurosurg Spine. It is easier to confuse a jury than convince a judge: the crisis in medical malpractice. Intraoperative and postoperative complications were recorded by the authors and the results were evaluated by an independent observer. Hardware problems were those related to the physical change of metal and screw position. An official website of the United States government. Health Aff (Millwood). At the lumbosacral area, breakage of a divergent screw of a Chopin block occurred on only one side with no loss of correction. Sub-analysis of adolescent idiopathic scoliotic patients showed no curve or patient characteristic that correlated with IMP or SAR. Two patients had early postoperative postural headache that disappeared after removal of the misplaced screw. Dr. Shaffrey has received grants from the NIH and Department of Defense. ObjectThe goal of this study was to determine the incidence of screw misplacement and complications in a group of 102 patients who underwent transpedicle screw fixation in the lumbosacral spine with conventional open technique and intraoperative. Spine (Phila Pa 1976). Amount awarded to plaintiffs by US region, adjusted for inflation as of April 2020. 1,12,19,22 The largest series of adjacent segment breakdown was reported by Schlegel et al. Spine 18:983991, 1993. 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. The defendants explanation provided an explanation for why Nyquists foot drop did not resolve after the misplaced screw was removed and shed doubt on the plaintiffs theory of liability. The remaining two patients had asymptomatic junctional problems develop after two- and three-segment fusions, at the third and fourth postoperative year, respectively. Lorenz M, Zindrick M, Schwaegler P, et al: A comparison of single level fusion with and without hardware. Likewise, cases are uploaded on a voluntary basis by state and federal judges and courts, which may lead to selection bias. Placement of the pedicle screws in the thoracolumbar and lumbar spine is a technically demanding procedure. A retrospective review of charts, XRs and low-dose CT scans of 127 patients who underwent spinal fusion with pedicle screws for spinal deformity was performed. Materials and Methods Sixty . 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%. The patient suffered permanent nerve damage as a result of the puncture. Gertzbein SD, Robbins SE: Accuracy of pedicular screw placement in vivo. Stauffer RN, Coventry MB: Posterolateral lumbar-spine fusion: Analysis of the Mayo clinic series. A total of 69 patients (mean age, 67.416 . Accessibility Don't jump in get legal help. A total of 2396 screws were placed accurately (87.96%). 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. We avoid using sharp automated drilling, and probe fully the pedicle cavity to prevent nerve root impairment. Your current browser may not support copying via this button. Dr. K. D. Than is a consultant for Bioventus and receives honoraria from DJO and LifeNet Health. Before Brodsky AE: Post-laminectomy and post-fusion stenosis of the lumbar spine. Clinical Orthopaedics and Related Research411:86-94, June 2003. Copyright 1944-2023 American Association of Neurological Surgeons, Copy this link, or click below to email it to a friend. However, the misplacement of pedicle screws can lead to disastrous complications. Louw JA, Dommissee GF, Roos MF: Spinal stenosis following anterior spinal fusion. The https:// ensures that you are connecting to the In situ spine arthrodesis permits load sharing by the vertebral bodies, preventing fatigue failure of the implant. Methods: Scarone P, Vincenzo G, Distefano D, et al. Schatlo B, Molliqaj G, Cuvinciuc V, et al. Cookie Policy. 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. Overall reported screw misplacement is low, but it does not reflect the potential impact on patient morbidity. pedicle screw: A rigid surgical implant used to stabilize adjacent spinal segments in spinal fusion surgery. 2011;306(10):1088. 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. 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. Drafting the article: Sankey. These risks can be minimized by the judicious use of instrumentation by experienced surgeons for specific indications as supported by the literature. 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. JAMA. 15. 22. Crawford MJ, Esses SI: Indications for pedicle fixation: Results of NASS/SRS faculty questionnaire: North American Spine Society and Scoliosis Research Society. Forty-seven intraoperative and medical complications were observed in 41 patients (36.6%). J Neurosurg. 2018;43(14):984990. reporting that the number of Medicare patients who underwent a complex lumbar spine fusion for spinal stenosis increased 15-fold, from 1.3 persons per 100,000 Medicare persons in 2002 to 19.9 in 2007.31 Similarly, a study by Rajaee et al. None of these complications resulted in additional surgery or in a significant increase of morbidity. Rajasekaran S, Bhushan M, Aiyer S, et al. Pedicle instrumentation in the thoracolumbar and lumbar spine is a technically challenging procedure. Waddell G, Kummell EG, Lotto WN, et al: Failed lumbar disc surgery and repeat surgery following industrial injuries. Spine 13:10121018, 1988. Nayar G, Blizzard DJ, Wang TY, et al. 25. Each side was judged separately. Problems at the junctions of the instrumented spine were seen in five patients (4.5%). Malpractice litigation and the spine: the NHS perspective on 235 successful claims in England. 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). Operative information including fusion level, number of levels fused, level of misplaced screw(s), single versus multiple misplaced screw(s), presence of known CSF leakage, and primary injury due to screw misplacement was also collected. 31. 2019;19(7):12211231. Two-dimensional (2D) fluoroscopy-guided percutaneous pedicle screw (PPS) placement is currently the most widely applied instrumentation for minimally invasive treatment of spinal injuries requiring stabilization. Am J Orthop. 2018;27(9):23392347. Problems of balance were coronal (scoliosis greater than 5 or trunk shift greater than 5 mm) as seen on the AP radiograph taken with the patient standing or sagittal (failure to obtain or maintain lumbar lordosis). Mukherjee S, Pringle C, Crocker M. A nine-year review of medicolegal claims in neurosurgery. PMC Epub 2014 Apr 4. It argued that the foot drop was unavoidable and due to the surgeons need to manipulate the right L5 nerve root in order to remove Nyquists herniated disc during the spinal fusion surgery. Clin Orthop 284:8090, 1992. Yuan HA, Garfin SR, Dickman CA, Mardjetko SM: A historical cohort study of pedicle screw fixation in thoracic, lumbar and sacral spinal fusions. However, the medicolegal impact of misplaced screws on spine surgery has not been directly reported in the literature. A Cotrel-Dubousset spinal system (Medtronic Sofamor Danek, Memphis, TN) was used in all patients and the total number of screws used was 658. The rod is held in place by "pedicle screws," which the surgeon must insert into the pedicles. J Neurosurg Spine. However, this is the first study to evaluate the direct medicolegal impact of misplaced pedicle and lateral mass screws on spine surgery in the US and presents important information that may support the routine use of intraoperative imaging confirmation (via 3D fluoroscopy or intraoperative CT) and/or navigated screw placement (either computer- or robot-assisted) as a potential method to decrease the risk of future litigation during spinal fusion procedures. Harris RI, Wiley JJ: Acquired spondylolysis as a sequel to spine fusion. 5. 2017;42(3):177185. One hundred four of the 112 patients had a posterior procedure. 144 In addition, seven (6.3%) dural tears occurred during the decompression and none occurred during instrumentation. 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. This site needs JavaScript to work properly. 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. 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. Comparetto, Esq., 727-328-7900, www.florida-malpractice-lawyers.com. Using chi square analysis, statistically significant correlation was seen between disc space narrowing and loss of postoperative correction (p < 0.01). Edwards CC: Spinal screw fixation of the lumbar and sacral spine: Early results treating the first 50 cases. 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. Therefore, when instrumentation is to be used, the benefits must outweigh the risks. There were 74 men and 38 women, with a mean age of 47 years (range, 1872 years). Mayo Clinic uses the latest robot-assisted technology when indicated to enhance surgical precision in these procedures. Statistical analysis: Sankey. All the incidental dural tears were repaired immediately and produced no clinical sequelae. 2. In the Kane County medical malpractice lawsuit of Melissa Nyquist v. Dr. Taras Masnyk and DuPage Neurosurgery, S.C., 06 L 421, the plaintiffs attorney was unable to convince the jury that the plaintiffs medical complications were caused by the defendants negligence. Saillant G: Etude anatomique des pedicules vertebraux: Application chirurgicale. 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. 11. Wiltse LL, Spencer CW: New uses and refinements of the paraspinal approach to the lumbar spine. $ = US$; MW = Midwest; NE = Northeast; SE = Southeast; SW = Southwest; W = West. 2009;10(1):3339. However, the defendant doctor maintained that Nyquists foot drop was not caused by the misplaced screw. 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. Cerebrospinal fluid fistulas. This retrospective study analyzes the complications and the problems developed during and after pedicle screw fixation in patients with spinal disorders and trauma. 8 spine surgeon insights, Lumbar spinal fusion cost in the 10 largest US cities, 2 MLB players undergo offseason spine surgeries, Salem Regional Medical Center adds spine surgeon, Here's how 6 spine surgeons prepare before a busy day, Total disc replacement cost in the 10 largest US cities, Study finds surgery more effective than conventional treatment for spinal stenosis, Dr. Rick Price completes his 50th AR spine case, Orthopedic surgeon among 2 convicted in $31M Medicare fraud scheme, SSM Health sues 2 resigning orthopedic surgeons, Surgeon leaves Rothman after 12 years to establish boutique spine practice, Jury awards $9.2M in botched spine surgery case, 'The numbers don't lie': Endoscopy to become more prominent among next generation of spine surgeons, Patient sues estate of late spine surgeon, 10 surgeons on the most controversial trends in spine, Connecticut orthopedic surgeon fined, reprimanded for operating on wrong hip, Ohio neurosurgeon facing wrongful death suit, Orthopedic surgeons at SSM Health resign, plan to start independent group, Wealthiest US orthopedic surgeon has a net worth of $1.8B, Orthopedic surgeons leaving SSM Health will partner with HOPCo for independent group, Wisconsin orthopedic surgeon sanctioned in patient's death, Healthgrades' best hospitals for spine surgery: 2023, How spine surgery competition is evolving by market: New York, Arizona, California and more, Indianapolis Colts linebacker has back surgery after consultation with Dr. Robert Watkins, Former Philadelphia Eagles player wins $43.5M verdict in knee injury case, California hospital cleared in counterfeit spine implant case, Georgia orthopedic clinic settles kickback suit, 22 hospitals ranked top 25 orthopedic hospitals 3+ years in a row, Stryker vs. Johnson & Johnson vs. Zimmer Biomet: How they compare in Q3, Neurosurgeon sentenced 5 years for accepting $3.3M in bribes, 12 surgeons who are leaving orthopedic groups for private practices, SSM Health canceling procedures as 11 orthopedic surgeons begin early departure, Aetna revises lumbar disc replacement policy, Indiana orthopedic surgeon settles Medicaid fraud allegations for $700K, 2 orthopedic hospitals facing Medicare readmission penalties, University of Toledo Medical Center suspends orthopedic chair, Here's what HOPCo's 1st Wisconsin partnership will look like, 2 Florida orthopedic providers merge to form 17-physician practice, 'This system is unsustainable': Why orthopedic surgeons do not feel fairly compensated, Orthopedic surgeon convicted for $31M staged fall scheme, Orthopedic surgeon buys $2M Chicago church, plans to convert to community hub, New Hampshire orthopedic surgeon arrested for alleged patient abuse, 8th Annual Becker's Health IT + Digital Health + RCM Annual Meeting.
Nfl Dropped Passes By Player 2021,
Watford Town Hall Vaccination Centre Telephone Number,
Articles P