pedicle screw misplacement malpractice

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. 2. 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. Median screw misplacement rate was 10% in group A and 13% in group B. There were 74 men and 38 women, with a mean age of 47 years (range, 1872 years). Results. The average followup was 35 months (range, 1851 months). Spinal fusion procedures are increasingly performed each year, with Deyo et al. 2002;27(22):24252430. When adjusted for inflation, these values increased to $1,330,201 $882,023 versus $970,832 $381,619, respectively (p = 0.32; Fig. West et al 33 also reported a 29% complication rate for the first 50 patients and a 26% complication rate for the last 74 patients. 5. Fortunately, most of the complications were minor and transient. The rate of reoperation for screw misplacement per screw was 0.17%. Balch CM, Oreskovich MR, Dyrbye LN, et al. Din RS, Yan SC, Cote DJ, et al. Neurosurgical practice liability: relative risk by procedure type. matte black square deadbolt; roberts point park fishing report; qr code on binax covid test; mff premium character list. were excluded from analysis. 2014;96(4):266270. In patients with degenerative conditions, all of the affected segments were included in the instrumentation and each vertebra was fixed with two pedicle screws. Wiltse LL, Spencer CW: New uses and refinements of the paraspinal approach to the lumbar spine. Screw misplacement. Phone/Fax: 30-2810-318361; E-mail: [emailprotected]. Rev Chir Orthop Reparatrice Appar Mot 62:151160, 1976. Litigation resulted in average payouts of $1,204,422 $753,832 between 1995 and 2019, when adjusted for inflation. 10. The plaintiff underwent revision surgery in May 2013. 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. PURPOSE This study aimed to compare rates of perioperative complications between robotic-assisted and conventional . 2012;7(6):e39237. Three-dimensional printing versus freehand surgical techniques in the surgical management of adolescent idiopathic spinal deformity. However, the defendant doctor maintained that Nyquists foot drop was not caused by the misplaced screw. Agarwal N, Gupta R, Agarwal P, et al. Sub-analysis of adolescent idiopathic scoliotic patients showed no curve or patient characteristic that correlated with IMP or SAR. Lumbar Spine Surgery. Neurosurgery. A review of medicolegal malpractice suits involving cervical spine: what can we learn or change? 27. Misplaced pedicle and lateral mass screws result in a considerable risk of malpractice litigation against spine surgeons. Elizabeth Hofheinz, M.P.H., M.Ed. Notwithstanding these concessions, the MDU argued that misplacement of pedicle screw tracts was common in surgery of this kind, even in experienced and competent hands. J Neurosurg Spine. We avoid using sharp automated drilling, and probe fully the pedicle cavity to prevent nerve root impairment. Unfortunately, the plaintiffs attorney was unable to offer an alternative theory of surgical negligence that would refute the defendants explanation. 21. One hundred twelve patients were treated using the Cotrel-Dubousset pedicle screw fixation system for degenerative disease (57 patients), trauma (42 patients), infection (eight patients), and tumor (five patients) of the lumbar or thoracolumbar spine. Dr. Abd-El-Barr is a consultant for Spineology. States were then grouped by US region and case year by 5-year intervals. Spine 15:908912, 1990. $ = US$; MW = Midwest; NE = Northeast; SE = Southeast; SW = Southwest; W = West. Lawsuit information regarding the plaintiffs age at the time of the malpractice claim, sex, postoperative complaint, indication for index surgery, defendant surgeon specialty (neurosurgery vs orthopedics), and delayed diagnosis or treatment, as well as case location by state and case year, was obtained. JAMA. 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. Nahed BV, Babu MA, Smith TR, Heary RF. 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. Of note, the award amount for one settlement case was undisclosed. Copyright 1944-2023 American Association of Neurological Surgeons, Copy this link, or click below to email it to a friend. It is easier to confuse a jury than convince a judge: the crisis in medical malpractice. The site is secure. 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. All the operations were done by one surgeon (PK). 26. The median time to case closure was 56.3 (35.267.2) months when ruled in favor of the plaintiff (i.e., patient) compared to 61.5 (51.477.2) months for defendant (surgeon) verdicts (p = 0.117). A total of 247 screws (9.07%) were BMP, 52 (1.91%) were IMP, and 29 (1.06%) were considered SAR. doi: 10.1097/BPO.0000000000001828. 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. Potential complications may include increased pain, infection, or mechanical . Fager CA. Whitecloud III TS, Butler JC, Cohen JL, Candelora PD: Complications with the variable spinal plating system. Nottmeier EW, Seemer W, Young PM. Federal government websites often end in .gov or .mil. 2018;41(5):e615e620. 2012;21(suppl 2):S196S199. A total of 2396 screws were placed accurately (87.96%). Problems at the junctions of the instrumented spine were seen in five patients (4.5%). Another possible cause was the high lateral torques to the entire frame that occurred during tightening of the tulip screw. 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. 32. 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. Achieving proper lumbar lordosis, evaluating any preexisting scoliosis, and intraoperative assessment with AP radiographs could prevent balance problems. 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. 2011;306(10):1088. 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. Hardware problems were those related to the physical change of metal and screw position. The plaintiff will recover $2.25 million because of a high-low agreement the lawyers entered after closing arguments, the New Jersey Law Journal reports. Spine 16(8 Suppl):S455458, 1991. 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. 2017;42(3):177185. Morphometric analysis of the proximal thoracic pedicles in Lenke II and IV adolescent idiopathic scoliosis: an evaluation of the feasibility for pedicle screw insertion. 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. Malpractice claims in spine surgery in Germany: a 5-year analysis. (PDF) Accuracy of pedicle screw placement in the lumbosacral spine 34. These numbers are in line with the current literature. Spine 16:576579, 1991. Autor de la entrada Por ; Fecha de la entrada austin brown musician; matrix toners for bleached hair . Brodsky AE: Post-laminectomy and post-fusion stenosis of the lumbar spine. 6. 2017;27(4):470475. Screws were divided into four categories: screws at risk (SAR), indeterminate misplacements (IMP), benign misplacements (BMP), accurately placed (AP). This retrospective study analyzes the complications and the problems developed during and after pedicle screw fixation in patients with spinal disorders and trauma. 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. Although the rate of the reported complications was high, the final outcome of the patients was not affected significantly. Both issues represent the most frequent and highest payouts in spine malpractice claims.10,14,22 While several studies have explored many of the factors related to malpractice claims in spine surgery, the medicolegal impact of misplaced pedicle and/or lateral mass screws has not been directly reported in the literature. 2018;83(5):9971006. SECTION I SYMPOSIUM: Advances in Spine Surgery, Distribution of Spinal Disorders in 112 Patients, Classification of Complications in 64 patients. However, the misplacement of pedicle screws can lead to disastrous complications. Debate Over Extent of Eye Damage Following Implant Lens Surgery Leads to $1 Million Verdict in Zaleski v Elmhurst Eye Surgery Center. Rynecki ND, Coban D, Gantz O, et al. 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. 4. There were nine instrumentation failures at the thoracolumbar area (seven patients), lumbar area (one patient), and lumbosacral area (one patient). Cases involving wrong-level or -side surgery, implant malfunction, or other misplaced spinal instrumentation (e.g., interbody cases, rods, surgical instruments, etc.) Quinnell RC, Stockdale HR: Some experimental observations of the influence of a single lumbar floating fusion on the remaining lumbar spine. The medicolegal landscape of spine surgery: how do surgeons fare? 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. 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.