Comparetto, Esq., 727-328-7900, www.florida-malpractice-lawyers.com. The last two patients had a T12L1 fracture-dislocation and a L4L5 spondylolytic spondylolisthesis at the site of plug dislodgments. The medicolegal landscape of spine surgery: how do surgeons fare? single homes for sale in lehigh valley, pa Using Low-Dose, Biplanar Imaging to Reduce Screw Misplacement 2017 Mar;5(2):109-116. doi: 10.1016/j.jspd.2016.10.007. All these problems were observed only just above the upper instrumentation level and all were observed in patients older than 55 years. Clinical Orthopaedics and Related Research411:86-94, June 2003. Three slender patients complained of soft tissue irritation and a bothersome prominence because of the screws bulky profile. Plaintiff's expert was prepared to testify at trial that these complaints are characteristic of a malpositioned screw impinging upon a neural structure. (PDF) Lumbosacral pedicle screw placement using a fluoroscopic pedicle 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. In their meta-analysis of nine randomized controlled trials, Li et al. Preparation. Pedicle screw fixation is commonly used in spinal instrumentation surgeries to connect rods to vertebrae in order to correct spine alignment, stabilize vertebrae, and reach an arthrodesis. Before Int Orthop 20:3542, 1996. Results. 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 average age of the patients was 47 years and the average followup was 35 months. Submitting a contact form, sending a text message, making a phone call, or leaving a voicemail does not create an attorney-client relationship. (A) Anteroposterior and (B) lateral radiographs show coronal imbalance that developed 4 years after surgery in a 57-year-old woman with L3L4 float fusion. Furthermore, 25 patients (22.3%) reported persistent pain in the iliac crest (donor graft site) for several months, for which they were treated with repeated lidocaine injections and analgesics. Neurosurgery. Orthopedics. Overall reported screw misplacement is low, but it does not reflect the potential impact on patient morbidity. Complete degeneration of the upper disc developed in two patients who had spinal stenosis and degenerative scoliosis. 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. Spine surgery has been disproportionately impacted by medical liability and malpractice litigation, with the majority of claims and payouts related to procedural error. Katonis PG, Kontakis GM, Loupasis GA, et al: Treatment of unstable thoracolumbar and lumbar spine injuries using Cotrel-Dubousset instrumentation. Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. 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. Hsu K, Zucherman JF, White AH: Internal Fixation With Pedicle Screws. JAMA. A total of 2396 screws were placed accurately (87.96%). 19. 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. 16. Spine 6:263267, 1981. 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. Pedicle instrumentation in the thoracolumbar and lumbar spine is a technically challenging procedure. J Spinal Disord Tech. Pedicle screw insertion techniques: an update and review of the However, the impact of robotic-assisted spinal fusion on patient outcomes is less clear. 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. Please try again soon. In addition, studies have shown that over 85% of malpractice claims are either dismissed or settled out of court,14 which likely results in a high degree of underreporting. In the remaining patients, the standard construct was three-segment fixation spanning four vertebrae and three discs, two above and one below the fractured vertebra, using six screws. Delayed open treatment of aortic penetration by a thoracic pedicle PURPOSE This study aimed to compare rates of perioperative complications between robotic-assisted and conventional . Introduction. Objective: Pedicle screw insertion - AO Foundation Spine 13:10121018, 1988. Am J Transl Res. Hadjipavlou A, Enker P, Dupuis P, Katzman S, Silver J: The causes of failure of lumbar transpedicular spinal instrumentation and fusion: A prospective study. Achieving proper lumbar lordosis, evaluating any preexisting scoliosis, and intraoperative assessment with AP radiographs could prevent balance problems. Using chi square analysis, statistically significant correlation was seen between disc space narrowing and loss of postoperative correction (p < 0.01). Of note, the award amount for one settlement case was undisclosed. Sub-analysis of adolescent idiopathic scoliotic patients showed no curve or patient characteristic that correlated with IMP or SAR. However, the highest offer had been a combined $300,000 from the two defendants. Pedicle screw replacement in spinal surgery - The MDU 2013;123(9):20992103. Materials and Methods Sixty . To prevent general complications, it is evident that precise and careful soft tissue handling, proper irrigation, and debridement during and after surgery, decrease of operative time, and proper patient monitoring postoperatively must be done. 2014;21(3):320328. Nahed BV, Babu MA, Smith TR, Heary RF. 24. Clin Orthop 203:7598, 1986. It is easier to confuse a jury than convince a judge: the crisis in medical malpractice. 35. Mason A, Paulsen R, Babuska JM, et al. laterally placed screws and the azygous vein on the right (T5-T11). This decision must be made on a case-by-case basis at the surgeons and patients discretion after a thorough discussion of the associated risks and benefits of revision surgery. Dalenberg DD, Asher MA, Robinson RG, Jayaraman G: The effect of a stiff spinal implant and its loosening on bone mineral content in canines. Ann R Coll Surg Engl. 2020;45(2):E111E119. 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). Clinical Orthopaedics and Related Research, Get new journal Tables of Contents sent right to your email inbox, The Association of Bone and Joint Surgeons, Complications and Problems Related to Pedicle Screw Fixation of the Spine, Articles in Google Scholar by Pavlos Katonis, MD, Other articles in this journal by Pavlos Katonis, MD, Privacy Policy (Updated December 15, 2022). 2014;20(2):196203. This retrospective analysis of 68 closed medicolegal cases related to misplaced screws in spine surgery showed that neurosurgeons and orthopedic spine surgeons were equally named as the defendant (n = 32 and 31, respectively), and cases were most commonly due to misplaced lumbar pedicle screws (n = 41, 60.3%). Excessive hemorrhage occurred in two patients (1.8%) with coagulation disorders. Pedicle screw placement: Robotic assistance for greater precision The jury found the defendants liable and allocated 75 percent of the fault to Dr. Friedlander and 25 percent to Dr. Bradley. General complications were considered those developing during and after surgery that were not directly related to instrumentation. J Neurosurg Spine. All the incidental dural tears were repaired immediately and produced no clinical sequelae. 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. Spine 19:25842589, 1994. George Sapkas, MD, DSc; and Panayiotis J. Papagelopoulis, MD, DScGuest Editors. 5. Pedicle Screw Malposition Expert Witness: Malposition Can Lead to FOIA Likewise, research shows that breaches still occur when these tools are used,33,40 and some studies did not find a difference in pedicle breach rates compared to those with traditional fluoroscopic and freehand techniques.33 Ultimately, misplaced instrumentation is a risk of any spinal fusion surgery, and a thorough discussion of these risks, as well as the alternative management options, is essential to maintain high-quality patient care and to avoid litigation. Saillant G: Etude anatomique des pedicules vertebraux: Application chirurgicale. Pitfall: Unstable injuries. J Bone Joint Surg 61A:201207, 1979. Results: Breakage of a divergent screw of a Chopin block at the lumbosacral area was seen 3 months after surgery. Retrospective analysis of reasons and revision strategy for failed thoracolumbar fracture surgery by posterior approach: a series of 31 cases. Despite commonly used, questions remain about their safety especially for the thoracic spine and in deformity where difficulty in positioning can lead to pedicle breach and adjacent structures injury. Although the rate of the reported complications was high, the final outcome of the patients was not affected significantly. Acquisition of data: Sankey. Thoracic pedicle screw placement: Free-hand technique - Bioline 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. 2,24,28,36. Spine 14:472476, 1989. 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. Grubb SA, Lipscomb HJ: Results of lumbosacral fusion for degenerative disc disease with and without instrumentation: Two- to five-year follow-up. $2 Million Spinal Surgery Case Against Neurosurgeon and Hospital Similarly, the highest inflation-adjusted amount awarded ($2,302,472) for pseudarthrosis was attributed to a medially breached pedicle screw during an L5S1 fusion that was determined to have caused the failed union and subsequent need for revision surgery. Please enable it to take advantage of the complete set of features! One of the common means of doing so is to place a screw into each of two adjacent spinal bones (vertebrae), and then a rod between them. Elizabeth Hofheinz, M.P.H., M.Ed. Edmunds I, Cummine J, Fearnside M: Prevention of dislodgement of Cotrel-Dubousset rods from tulip screws. 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. Pedicle screw accuracy in thoracolumbar fractures- is routine postoperative CT scan necessary? In 2 patients, misplacement of pedicle screws was recognized intraoperatively and all implants were removed.

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