In two patients in the current series, dislodgement of the rods from tulip screws occurred, as reported originally by Edmunds et al. Surg Neurol. Epub 2014 Jun 13. In the other patient, L4L5 float arthrodesis was done. 35. The case facts centered on a spinal surgery the 34 year-old plaintiff had undergone at Central DuPage Hospital. Misplacement of Pedicle Screws Leads to Years of Pain and Opioid Addiction Nationally Recognized Regionally Dominant Contact Us Now For a Free Consultation Over $850 Million in Verdicts and Settlements Home Articles Misplacement of Pedicle Screws Leads to Years of Pain and Opioid Addiction You are talking one of the most complicated area of the law. 27,30 Infected pseudarthrosis developed in one patient (0.9%) with an L4S1 arthrodesis, and the instrumentation was removed 18 months later resulting in a flat back syndrome. Spine 14:472476, 1989. Malpractice risk according to physician specialty. were excluded from analysis. Zdeblick TA: A prospective randomized study of lumbar fusion: Preliminary results. Din RS, Yan SC, Cote DJ, et al. The medicolegal landscape of spine surgery: how do surgeons fare? Dr. Shaffrey has received grants from the NIH and Department of Defense. 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. Surg Neurol Int. Phone/Fax: 30-2810-318361; E-mail: [emailprotected]. Previous biomechanical and clinical studies defining junctional segment problems are lacking and consist mainly of case reports. 2013;32(1):111119. 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. 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. 2020;162(6):13791387. Complete degeneration of the upper disc developed in two patients who had spinal stenosis and degenerative scoliosis. Results: A total of 2724 screws were placed in 127 patients. Taylor CL. Balch CM, Oreskovich MR, Dyrbye LN, et al. $2 Million Spinal Surgery Case Against Neurosurgeon and Hospital Would you like email updates of new search results? Thus, we are unable to comment on whether all misplaced screws, particularly when asymptomatic, should be revised in an effort to prevent litigation. 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. EOS System Courtesy of EOS imaging. 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. Neurologic injury. J Bone Joint Surg 45A:11591170, 1963. 2014;96(4):266270. The site is secure. 2018;83(5):9971006. Conclusion: PLoS One. A total of 69 patients (mean age, 67.416 . Several studies reveal that fusion rates increase when rigid internal fixation is used, 14,20,21,33,38 and that by using pedicle screws and plates or rods for stabilization, spinal arthrodesis can be limited to the disease segments. INCLUDE WHEN CITING DOI: 10.3171/2020.8.FOCUS20600. reported that 69.3% of neurosurgeons who responded to their survey saw every patient as a potential lawsuit.1. 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. Malpractice litigation and the spine: the NHS perspective on 235 successful claims in England. 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. One hundred four of the 112 patients had a posterior procedure. Scarone P, Vincenzo G, Distefano D, et al. The patient had subsequent coronal imbalance and degeneration of the upper disc. Schlegel JD, Smith JA, Schleusener RN: Lumbar motion segment pathology adjacent to thoracolumbar, lumbar, and lumbosacral fusions. Pedicle screw accuracy in thoracolumbar fractures- is routine Background The objective of this cadaveric study was to analyze the effects of iatrogenic pedicle perforations from screw misplacement on the mean pullout strength of lower thoracic and lumbar pedicle screws. 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. Median screw misplacement rate was 10% in group A and 13% in group B. What can spine surgeons do to improve patient care and avoid medical negligence suits? In unstable injuries, the segments above and below the level of injury may have a different orientation of the pedicle trajectory due to . 2013;34(6):699705. 4). 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. 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). Procedural errors led to combined payouts totaling $124,943,933 in neurosurgery claims between 2003 and 2012 in a study looking at data from the Physician Insurers Association of America Data Sharing Project.10 However, our study is the first to report the direct medicolegal impact of screw misplacement on US spine surgery, with 30.9% of judgments/settlements in favor of the plaintiff, resulting in average payouts of $1,204,422 $753,832 per claim. Mohar J, Vali M, Podovovnik E, Mihali R. Eur Spine J. 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. Safety and accuracy of robot-assisted versus fluoroscopy-guided pedicle screw insertion for degenerative diseases of the lumbar spine: a matched cohort comparison. Placement of thoracolumbar pedicle screws using three-dimensional image guidance: experience in a large patient cohort. West III JL, Bradford DS, Ogilvie JW: Complications of the variable screw pedicle screw fixation. This study quantifies the rate of screw misplacement on a per-patient basis to highlight its effect on potential morbidity. Twenty-one patients (18.8%) had thoracolumbar injuries, and loss of immediate postoperative deformity correction ranged from 1.4 to 4.5. 2,24,28,36. Ultimately, additional prospective, multiinstitutional large-volume studies are needed to validate these findings, and future studies should evaluate the long-term impact on the routine use of intraoperative imaging confirmation and/or computer- or robot-assisted navigation on the frequency and success of malpractice claims related to misplaced pedicle and lateral mass screws. Katonis, Pavlos MD*; Christoforakis, Joseph MD*; Aligizakis, Agisilaos C. MD*; Papadopoulos, Charalampos MD*; Sapkas, George MD, DSc**; Hadjipavlou, Alexander MD*. 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. Dalenberg DD, Asher MA, Robinson RG, Jayaraman G: The effect of a stiff spinal implant and its loosening on bone mineral content in canines. Unilateral nonunion was seen in three patients (2.7%), associated with implant failure in one of the patients. Br J Neurosurg. Smith TR, Hulou MM, Yan SC, et al. After the removal of duplicates, a total of 68 unique cases met our inclusion criteria and were included for analysis. Before Defensive medicine: a culprit in spiking healthcare costs. Lumbar Spine Surgery. 28. The rate of misplaced pedicle screws ranges from 1.1% to 28.8%, 10 although neurologic injury from misdirected pedicle screws has been reported to occur in 0% to 12% of patients. This step in implant evolution was inevitable, because prior phases of implant development did not control each plane of motion segment stress. 1. The average followup was 35 months (range, 1851 months). The pedicle screws judged as misplacement. a Medial minor perforation Summary of background data: Data is temporarily unavailable. 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. 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. Guillain A, Moncany AH, Hamel O, et al. 8,24,25,32. 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). Placement of the pedicle screws in the thoracolumbar and lumbar spine is a technically demanding procedure. Spine 17:349355, 1992. 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. 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. Forty-seven general complications were seen in 41 patients (36.5%). Reoperation for Misplaced Pedicle Screws: A Multicenter Retrospec It was firstly introduced by Harrington and Tullos in 1969 and then in late 1980s developed by Roy Camille et al., Louis, and Steffe. pedicle screws sagittal alignment spinal fusion surgical guides Spinal fusion is used to treat a range of conditions associated with spinal column such as intervertebral disc degeneration and scoliosis [ 1 ]. The https:// ensures that you are connecting to the PURPOSE This study aimed to compare rates of perioperative complications between robotic-assisted and conventional . Accuracy of C2 pedicle screw placement using the anatomic freehand Please enable it to take advantage of the complete set of features! These numbers are in line with the current literature. Although the rate of the reported complications was high, the final outcome of the patients was not affected significantly. Malpractice liability and defensive medicine: a national survey of neurosurgeons. Grubb SA, Lipscomb HJ: Results of lumbosacral fusion for degenerative disc disease with and without instrumentation: Two- to five-year follow-up. Percentage of cases per US region (center). Therefore, when instrumentation is to be used, the benefits must outweigh the risks. 37. Spine 13:696706, 1988. J Neurosurg Spine. 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. 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. JAMA Intern Med. Clin Orthop 203:4553, 1986. Preparation. All Rights Reserved. Spine 18:11601172, 1993.
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