pedicle screw misplacement malpractice

EOS System Courtesy of EOS imaging. Although the rationale for using pedicle screw fixation is fairly clear, controversy continues regarding the application of pedicle instrumentation for spine arthrodesis, especially on the degenerative lumbar spine. single homes for sale in lehigh valley, pa single homes for sale in lehigh valley, pa Home Realizacje i porady Bez kategorii single homes for sale in lehigh valley, pa Retrospective analysis of reasons and revision strategy for failed thoracolumbar fracture surgery by posterior approach: a series of 31 cases. Please do not include any confidential or sensitive information in a contact form, text message, or voicemail. Ultimately, no significant differences were seen in inflation-adjusted award information between plaintiff and defendant (Table 3). One common area for the potential avoidance of malpractice claims and subsequent payouts involves misplaced pedicle and/or lateral mass instrumentation. Pedicle screw placement is a common procedure. 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. The medicolegal impact of misplaced pedicle and lateral mass screws on Reoperation for Misplaced Pedicle Screws: A Multicenter Retrospec 2014;21(3):320328. 16,24,28 Simultaneously, the evolution of the surgical techniques has led to increased procedural safety. Jury Verdict for Doctor for Screw Allegedly Misplaced During Lumbar In the current study, no incidence of bent and broken screws or tulip screw plug dislodgement necessitated additional treatment, and all the patients achieved solid fusion despite the failure of instrumentation. shooting in valdosta leaves one dead Federal government websites often end in .gov or .mil. 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). There were nine instrumentation failures at the thoracolumbar area (seven patients), lumbar area (one patient), and lumbosacral area (one patient). Statistical analysis: Sankey. The initial search using the terms above returned 3654 cases. The contact form sends information by non-encrypted email, which is not secure. However, 5-10% of those misplaced screws are cause for concern." "To rectify this, we must have access to imaging devices during the procedure. The pedicle screw system is widely used in spine surgery, and it provides rigid fixation and leads to successful subsequent deformity correction and bony fusion. 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 instrumentation in the thoracolumbar and lumbar spine is a technically challenging procedure. Mississippi Appellate Court Affirms Medical Malpractice Defense Verdict 2014;20(6):636643. 2018;83(5):9971006. 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. Elizabeth Hofheinz, M.P.H., M.Ed. Spine (Phila Pa 1976). Rev Chir Orthop Reparatrice Appar Mot 62:151160, 1976. 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. Pedicle screw fixation is an effective but demanding method to treat various spinal disorders and is associated with a significant complication rate. Risk Factors for the Drift Phenomenon in Oarm NavigationAssisted 2012;21(suppl 2):S196S199. 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. 1 To be effective, the pedicle screw constructs must withstand intraoperative loading and physiological forces due to daily postoperative activities. government site. 2016;102(2):358362. J Neurosurg Spine. Although the rate of the reported medical complications was high (36.5%), these did not significantly affect the final clinical outcome of the current patients. Both of these patients complained of thigh pain but refused any additional surgery. 2016;124(5):15241530. In six patients (5.3%) with degenerative spine disease, the disc material had been removed. 70% of Pedicle Screws are misplaced - orthostreams.com Screws were divided into four categories: screws at risk (SAR), indeterminate misplacements (IMP), benign misplacements (BMP), accurately placed (AP). Safety and accuracy of robot-assisted versus fluoroscopy-guided pedicle screw insertion for degenerative diseases of the lumbar spine: a matched cohort comparison. Instrumentation removal is an option for patients with successful arthrodesis, but remains controversial. Mukherjee S, Pringle C, Crocker M. A nine-year review of medicolegal claims in neurosurgery. Spine (Phila Pa 1976). 2012;37(1):6776. your express consent. Despite this problem, the clinical result was excellent. An official website of the United States government. Laryngoscope. Thus, we are unable to comment on whether all misplaced screws, particularly when asymptomatic, should be revised in an effort to prevent litigation. Thirty-five (27.56%) had IMP and 18 (14.17%) had SAR. Dr. Abd-El-Barr is a consultant for Spineology. This study revealed an overall accuracy rate of 95.2% of mainly percutaneously inserted pedicle screws according to the classification of Zdichavsky et al. Plaintiff-awarded cases by US region (left). Patient safety: disclosure of medical errors and risk mitigation. Thoracic pedicle screw placement: Free-hand technique - Bioline Agarwal N, Gupta R, Agarwal P, et al. While the majority of claims are found to lack merit, resulting in a verdict in favor of the defendant or case dismissal,7,1316 at least 37% are considered valid.26 Regardless, payouts to plaintiffs are often substantial, averaging in the hundreds of thousands to millions of dollars in both the US and Europe.10,11,14,17,20 Communication of errors and expectations, thorough documentation, and selection of appropriate patients and surgical indications have been shown to reduce the likelihood of a successful malpractice claim.13,16,27,28 In addition, attempts at tort reform in some states have helped limit the financial burden of medical malpractice payouts through methods such as capitation.16,20,22,26 However, efforts to limit malpractice claims in the first place are greatly needed. To reinforce spinal fixation, we have proposed a construct with segmental pedicle fixation two levels above and one level below the injured level and insertion of a screw deep into the pedicle, providing more contact area between screw head and bone and reducing the moment arm of the bending stress. The rod is held in place by "pedicle screws," which the surgeon must insert into the pedicles. 2012 Feb 1;37(3):E188-94. Makhni MC, Park PJ, Jimenez J, et al. 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. The standard imaging technique for pedicle screw insertion is two-dimensional images obtained from C-arm-type X-ray fluoroscopy. In the current series, there were no cases of screw misplacement or vascular or neurologic complications caused by implant application. 18. 37. Weinstein JN, Spratt KF, Spengler D, Brick C, Reid S: Spinal pedicle fixation: Reliability and validity of roentgenogram-based assessment and surgical factors on successful screw placement. Gertzbein SD, Robbins SE: Accuracy of pedicular screw placement in vivo. pedicle screw misplacement malpractice 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. 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. Medical malpractice litigation has made a significant impact on spine surgery, with many spine surgeons avoiding complex cases or practicing other defensive medicine tactics in an effort to avoid being sued.5 Moreover, the majority of neurosurgeons spend more than 10% of their annual revenue on malpractice insurance,1,14 and the excessive financial risk of litigation is even leading some insurers to no longer offer coverage to spine surgeons.19 A 2011 study in the New England Journal of Medicine found that 19.1% of neurosurgeons are named as a defendant in a malpractice suit each year (highest of any specialty).12 Moreover, 88% of physicians in high-risk specialties, like neurosurgery, are involved in a lawsuit by age 45, increasing to a concerning 99% by 65 years of age.12 Such litigation places a substantial financial, temporal, and emotional burden on physicians in high-risk specialties, with studies showing that up to 72% of neurosurgeons1 admitted that their fear of litigation significantly influenced their practice,25 with many avoiding high-risk patients altogether.1 Similarly, Nahed et al. Spine 13:696706, 1988. HHS Vulnerability Disclosure, Help McLaughlin WM, Donnelley CA, Yu K, Gillinov SM, Tuason DA. Two patients had early postoperative postural headache that disappeared after removal of the misplaced screw. Plaintiff's expert was prepared to testify at trial that these complaints are characteristic of a malpositioned screw impinging upon a neural structure. Accessibility 5. 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. Cookie Policy. Conception and design: Sankey, KD Than. JAMA Intern Med. The screws were needed to stabilize the spine and fix the fused vertebrae in place. A rod is used to hold the vertebra together to allow fusion to occur. National Library of Medicine The highly litigious environment within healthcare has resulted in a majority of physicians practicing defensive medicine,15 often leading to burnout6,7 and an exorbitant ethical and financial burden on medical and surgical care.7,8 In 2008, medical liability accounted for $55.6 billion, representing 2.4% of the United States (US) healthcare expenditures that year,5,7,9,10 and the pervasive practice of defensive medicine may cost up to $210 billion annually in the US.5 A similar trend has been observed in Europe.11, Neurosurgery is the specialty most frequently affected by lawsuits and the fear of litigation, both in the US and abroad,12 with spine surgery at the forefront.11,1317 As a result, spine surgeons are nearly three times more likely than nonspine surgeons to practice defensive medicine, defined as the avoidance of high-risk procedures and the provision of unnecessary services and assessments beyond what is clinically necessary in an effort to avoid litagation.5 The average time to judgment in a case is approximately 5.1, 5.0, and 3.4 years for defendant verdicts, plaintiff rulings, and settlements, respectively.7,15 As a result, physicians spend an average of 11% of their careers dealing with one or more open malpractice claims.18 Neurosurgeons are especially impacted, spending an average of 27.2% of their careers in an open lawsuit.10. Of note, the award amount for one settlement case was undisclosed. PDF Intraoperative biomechanics of lumbar pedicle screw loosening following This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. 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. Critically revising the article: all authors. 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. None of these complications resulted in additional surgery or in a significant increase of morbidity. Each case was then carefully screened for relevance and sufficient data. Ahmadi SA, Sadat H, Scheufler KM, et al. Spine J. 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. A total of 2396 screws were placed accurately (87.96%). 3. Pediatric pedicle screw placement using intraoperative computed tomography and 3-dimensional image-guided navigation. Reviewed submitted version of manuscript: all authors. 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. 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%. 2. Spine (Phila Pa 1976). Risk factor analysis showed smaller Cobb angles increased likelihood of all screws being AP. 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. PLoS One. INCLUDE WHEN CITING DOI: 10.3171/2020.8.FOCUS20600. Potential complications may include increased pain, infection, or mechanical . Spine 6:263267, 1981. * Robotic-assisted pedicle screw placement fails to reduce overall Breakage of a divergent screw of a Chopin block at the lumbosacral area was seen 3 months after surgery. Placement of the pedicle screws in the thoracolumbar and lumbar spine is a technically demanding procedure. 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.

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