Acta Neurochir (Wien). Clin Orthop 203:126134, 1986. Jena AB, Seabury S, Lakdawalla D, Chandra A. Spine 19:25842589, 1994. Spine (Phila Pa 1976). Submitting a contact form, sending a text message, making a phone call, or leaving a voicemail does not create an attorney-client relationship. Sub-analysis of adolescent idiopathic scoliotic patients showed no curve or patient characteristic that correlated with IMP or SAR. 30. Krag MH, Beynnon BD, Pope MH, et al: An internal fixator for posterior application to short segment of the thoracic, lumbar, or lumbosacral spine. 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. 2013;32(1):111119. Drafting the article: Sankey. Show more. Epub 2022 Oct 29. 32. 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. * J Bone Joint Surg 45A:11591170, 1963. Instrumentation removal is an option for patients with successful arthrodesis, but remains controversial. Svider PF, Kovalerchik O, Mauro AC, et al. Methods. matte black square deadbolt; roberts point park fishing report; qr code on binax covid test; mff premium character list. 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. With pedicle shapes and sizes varying wildly in the scoliotic spine, misplacement of a screwas well as and under- or oversizingare real possibilities in spine surgery. Intraoperative and postoperative complications were recorded by the authors and the results were evaluated by an independent observer. Pedicle screw construct have become one of the most practiced procedure in spinal surgery. 1. 2018;28(2):186193. 2014 Sep;21(3):320-8. doi: 10.3171/2014.5.SPINE13567. 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. 31. 15. Malpractice claims in spine surgery in Germany: a 5-year analysis. This device was used with an early version of the Cotrel-Dubousset instrumentation to provide sacral fixation and it is rarely used since the more widespread use of newer spine fixation systems.
Jury Verdict for Doctor for Screw Allegedly Misplaced During Lumbar General complications were considered those developing during and after surgery that were not directly related to instrumentation. 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 laterally placed screws and the azygous vein on the right (T5-T11).
The rod is held in place by "pedicle screws," which the surgeon must insert into the pedicles. Pedicle screw insertions are commonly used for posterior fixation to treat various spine disorders. 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. The rate of reoperation for screw misplacement per screw was 0.17%. Better strategies need to be devised for evaluation of screw placement, including establishment of a national database of deformity surgery, use of intra-operative image guidance, and reevaluation of postoperative low-dose CT imaging. 8,24,25,32. Studdert DM, Mello MM, Sage WM, et al. 2011;213(5):657667. However, we did not observe any screw breakage in patients with a degenerative lumbar spine, and the absence of broken screws in this series is because arthrodesis in almost all patients occurred in situ. pedicle screw: A rigid surgical implant used to stabilize adjacent spinal segments in spinal fusion surgery. The patient had subsequent coronal imbalance and degeneration of the upper disc. Yuan HA, Garfin SR, Dickman CA, Mardjetko SM: A historical cohort study of pedicle screw fixation in thoracic, lumbar and sacral spinal fusions. 2014;21(3):320328. (%), Pseudarthrosis requiring revision surgery. The plaintiff received $2.4 million for pain and suffering and loss of enjoyment of life, $2 million for lost income and approximately $123,000 for medical expenses. The amount awarded was not significantly different across US regions (p = 0.9; Fig. The case facts centered on a spinal surgery the 34 year-old plaintiff had undergone at Central DuPage Hospital. In 2 patients, misplacement of pedicle screws was recognized intraoperatively and all implants were removed. 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. The site is secure. 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.
Jury awards $4.5M over misplaced pedicle screw during spine surgery: 5 Kreisman Law Offices has been handling Illinois surgical error lawsuits for individuals and families for more than 35 years in and around Chicago, Cook County and surrounding areas, including Batavia, Bellwood, Deerfield, Evanston, Franklin Park, and Lansing. Malpractice risk according to physician specialty. Acquisition of data: Sankey. Defendant-awarded cases by US region (right). Three slender patients complained of soft tissue irritation and a bothersome prominence because of the screws bulky profile. Spine (Phila Pa 1976). The defense pointed to the lack of evidence that the screw had ever come into contact with the L5 nerve root. 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. 2017 Mar;5(2):109-116. doi: 10.1016/j.jspd.2016.10.007. Seabury SA, Chandra A, Lakdawalla DN, Jena AB. Careers. Spine neurosurgeons facing the judicialization of their profession: disenchantment and alteration of daily practicea qualitative study. Illinois Jury Finds in Favor of Doctor in Gallbladder Surgery that Led to Fatal Bowel Perforation Nickl v. Barry S. Rosen, M.D. 2014;174(11):18671868. A TLIF is a surgical procedure that attempts to fuse vertebrae in order to stabilize the patient's spine. to maintaining your privacy and will not share your personal information without
CT-navigation versus fluoroscopy-guided placement of pedicle screws at Pedicle screw placement: Robotic assistance for greater precision Spine 19(20 Suppl):2279S2296, 1994. Saillant G: Etude anatomique des pedicules vertebraux: Application chirurgicale. Comparetto, Esq., 727-328-7900, www.florida-malpractice-lawyers.com. All the operations were done by one surgeon (PK). In their meta-analysis of nine randomized controlled trials, Li et al. Copyright 2023 Becker's Healthcare. Don't jump in get legal help.
Pullout performance comparison of pedicle screws based on cement Spine (Phila Pa 1976).
(PDF) Accuracy of pedicle screw placement in the lumbosacral spine Pedicle screw | definition of pedicle screw by Medical dictionary Edwards CC: Spinal screw fixation of the lumbar and sacral spine: Early results treating the first 50 cases. Daniels AH, Ruttiman R, Eltorai AEM, et al. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. 2018;43(14):984990. When adjusted for inflation, these values increased to $1,330,201 $882,023 versus $970,832 $381,619, respectively (p = 0.32; Fig. The remaining two patients had asymptomatic junctional problems develop after two- and three-segment fusions, at the third and fourth postoperative year, respectively. 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. 2. 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. 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. 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. Schlegel JD, Smith JA, Schleusener RN: Lumbar motion segment pathology adjacent to thoracolumbar, lumbar, and lumbosacral fusions. Incidence and costs of defensive medicine among orthopedic surgeons in the United States: a national survey study. Nevertheless, research has shown that screws are misplaced in approximately 14%55% of cases using the standard techniques (freehand and 2D fluoroscopic guidance) employed by most spine surgeons,21,33 resulting in injury in approximately 1%8% of cases.21 In addition to the avoidable procedural risk to the patient, each misplaced screw carries the threat of future litigation, as reported above. Forty-seven general complications were seen in 41 patients (36.5%). Bookshelf Dr. Karikari is a consultant for NuVasive, Globus, Johnson & Johnson, and DePuy and receives a spine fellowship fund from NuVasive. Previous biomechanical and clinical studies defining junctional segment problems are lacking and consist mainly of case reports. Cotrel Y, Dubousset J, Guillaumat M: New universal instrumentation in spinal surgery. 34. 2021 Nov;9(6):1541-1548. doi: 10.1007/s43390-021-00377-5. The standard imaging technique for pedicle screw insertion is two-dimensional images obtained from C-arm-type X-ray fluoroscopy. Deyo RA, Mirza SK, Martin BI. 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.
HHS Vulnerability Disclosure, Help With increasing pedicle screw usage, the number of patients with misplaced screws will likely increase proportionally. Your message has been successfully sent to your colleague. 4. 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. 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. JAMA Intern Med. The development of the transpedicle screw has provided control of the vertebral motion segment in each plane, resisting any type of load. We serve the following localities: Cook County including Arlington Heights, Barrington, Berwyn Township, Chicago, Des Plaines, Glenview, Orland Park, Palos Park, Schaumburg, and Tinley Park; DuPage County including Downers Grove, Naperville, and Bolingbrook; Kane County including Aurora, Elgin and Geneva; Lake County including Waukegan; and Will County including Joliet. None of these complications resulted in additional surgery or in a significant increase of morbidity. 16,24,28 Simultaneously, the evolution of the surgical techniques has led to increased procedural safety. pedicle screw misplacement malpractice. Medical malpractice in orthopedic surgery: a Westlaw-based demographic analysis. 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). Safety and efficacy of pedicle screw placement using intraoperative computed tomography: consecutive series of 1148 pedicle screws.
Partner, Paul M. da Costa, Obtains $4.5 Million Verdict - Snyder Sarno Fortunately, most of the complications were minor and transient. 144 Pedicle screw instrumentation is widely used for the stabilization of the subaxial cervical, thoracic, and lumbar spine. 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. Pedicle screw accuracy in thoracolumbar fractures- is routine postoperative CT scan necessary? For more information, please refer to our Privacy Policy. Spine 18:983991, 1993. The patient suffered permanent nerve damage as a result of the puncture. 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. Can Postoperative Radiographs Accurately Identify Screw Misplacements? Complications were classified as general, hardware-related, problems associated with the instrumented segments, junctional level problems, and problems related with balance (Table 2). Smith TR, Hulou MM, Yan SC, et al. Pedicle screw fixation is an effective but demanding method to treat various spinal disorders and is associated with a significant complication rate. Rather, the defense demonstrated that although the misplaced screw had in fact irritated the L4 nerve root for the six days before it was removed, the related symptoms resolved with the screws removal. Copyright 1944-2023 American Association of Neurological Surgeons, Copy this link, or click below to email it to a friend. South Med J 62:17, 1969. Unfortunately, the plaintiffs attorney was unable to offer an alternative theory of surgical negligence that would refute the defendants explanation. This retrospective study analyzes the complications and the problems developed during and after pedicle screw fixation in patients with spinal disorders and trauma. The https:// ensures that you are connecting to the 5. J Neurosurg Spine. Hardware problems were those related to the physical change of metal and screw position. 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. Therefore, when instrumentation is to be used, the benefits must outweigh the risks. 8600 Rockville Pike Placement of thoracolumbar pedicle screws using three-dimensional image guidance: experience in a large patient cohort. 1). 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).
Pullout strength of misplaced pedicle screws in the thoracic and lumbar This patient recovered completely in 6 weeks.
Open lumbar pedicle screw technique - Operative Neurosurgery The remaining eight patients, including two patients with spinal trauma, five patients with infection, and one patient with a tumor, had anterior and posterior procedures. All case demographics are summarized in Table 1. GraphPad Prism version 6.01 for Windows was used for all descriptive analyses (GraphPad Software). 1. Back pain/spinal stenosis and neurogenic claudication/radiculopathy were the most frequently reported indications for the index surgery, accounting for 13 (19.1%) and 11 (16.2%) cases, respectively. Despite this problem, the clinical result was excellent. Aigner R, Bichlmaier C, Oberkircher L, Knauf T, Knig A, Lechler P, Ruchholtz S, Frink M. BMC Musculoskelet Disord.
Thoracic Pedicle Screws - ScienceDirect 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. 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. The radiology results showed that the surgical screw placed at the right L4-5 area had breached the medial wall and was actually extending into the spinal canal. 21. Todd NV. Rovit RL, Simon AS, Drew J, et al. A CT scan was taken to try and identify the underlying neurological problem that might be causing the new symptom. Patient safety: disclosure of medical errors and risk mitigation, Neurosurgical practice liability: relative risk by procedure type. Eur Spine J. Hardware-related failures were observed in 12 patients (10.7%). Rynecki ND, Coban D, Gantz O, et al. Both of these patients complained of thigh pain but refused any additional surgery. Error in trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. Amount awarded to plaintiffs by US region, adjusted for inflation as of April 2020. This study quantifies the rate of screw misplacement on a per-patient basis to highlight its effect on potential morbidity.
pedicle screw misplacement malpractice Characteristics of medicolegal cases related to misplaced screws in spine surgery. 23. It should be used by experienced and qualified surgeons who are familiar with the pitfalls associated with its use. 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. Each side was judged separately.
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