pedicle screw misplacement malpractice

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. 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. Instrumentation removal is an option for patients with successful arthrodesis, but remains controversial. 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. Johnston II CE, Ashman RB, Baird AM, Allard RN: Effect of spinal construct stiffness on early fusion mass incorporation: Experimental study. Epub 2021 Aug 28. 2012;21(suppl 2):S196S199. Show more. PLoS One. 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. 17. Bookshelf The defense pointed to the lack of evidence that the screw had ever come into contact with the L5 nerve root. 20th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference, 8th Annual Health IT + Digital Health + RCM Conference, 29th Annual Meeting - The Business & Operations of ASCs, The issues spine surgeons are advocating for outside of the operating room, Centinel Spine is now covered by all major payers, What's next for SI joint fusion? (%), Pseudarthrosis requiring revision surgery. 20. 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. Safety and accuracy of robot-assisted versus fluoroscopy-guided pedicle screw insertion for degenerative diseases of the lumbar spine: a matched cohort comparison. [] The accuracy for free-hand screw placement technique varies from 69% to 94%. (PDF) Lumbosacral pedicle screw placement using a fluoroscopic pedicle Spine (Phila Pa 1976). Privacy Policy. 37. pedicle screw misplacement malpractice Thirty-five (27.56%) had IMP and 18 (14.17%) had SAR. Spine 16(8 Suppl):S422427, 1991. Are We Underestimating the Significance of Pedicle Screw Misplacement Recently, robot-assisted pedicle screw implantation has been increasingly utilized at large-volume academic centers. All the incidental dural tears were repaired immediately and produced no clinical sequelae. Neurosurgical practice liability: relative risk by procedure type. The accuracy rate of pedicle screw (PS) placement varies from 85% to 95% in the literature. 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. Two patients with associated injuries in the lower limbs had deep venous thrombosis develop, three patients had pneumonia develop, and four patients with neurologic impairment had urinary tract infections develop. Administrative/technical/material support: Mehta, Wang, KD Than. J Bone Joint Surg 61A:201207, 1979. The pedicle screws judged as misplacement. a Medial minor perforation Spine J. All case demographics are summarized in Table 1. sharing sensitive information, make sure youre on a federal 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. Spine 6:615619, 1981. Nominal and inflation-adjusted award payouts were higher for trial verdicts than for settlement/arbitration, with a nominal average of $1,140,473 $841,683 versus $788,533 $306,186 awarded to the plaintiff, respectively (p = 0.30). Instead, the defense offered up an alternative explanation for Nyquists foot drop. 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. 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. 2016;25(3):716723. 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. Orthopedics. To investigate intraoperative reinsertion of percutaneous pedicle screw (PPS) with intraoperative CT-based navigation and to evaluate the rate of deviation of PPS at postoperative radiographic examination. Clinical Orthopaedics and Related Research411:86-94, June 2003. However, this is the first study to evaluate the direct medicolegal impact of misplaced pedicle and lateral mass screws on spine surgery in the US and presents important information that may support the routine use of intraoperative imaging confirmation (via 3D fluoroscopy or intraoperative CT) and/or navigated screw placement (either computer- or robot-assisted) as a potential method to decrease the risk of future litigation during spinal fusion procedures. Whitecloud III TS, Butler JC, Cohen JL, Candelora PD: Complications with the variable spinal plating system. 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%. Each case was then carefully screened for relevance and sufficient data. 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. Screw Malposition: Are There Long-term Repercussions to Malposition of 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. Unauthorized use of these marks is strictly prohibited. Med Econ. As part of the surgery, Dr. Taras Masnyk inserted four metal screws into the plaintiffs spine. Unable to load your collection due to an error, Unable to load your delegates due to an error. Malpractice litigation following spine surgery. Neurological Outcome and Management of Pedicle Screws Misplaced Totally Nahed BV, Babu MA, Smith TR, Heary RF. 6 Comparetto, Esq., 727-328-7900, www.florida-malpractice-lawyers.com. There were 74 men and 38 women, with a mean age of 47 years (range, 1872 years). You are talking one of the most complicated area of the law. doi: 10.1097/BPO.0000000000001828. Clin Orthop 203:4553, 1986. Screw misplacement. laterally placed screws and the azygous vein on the right (T5-T11). Illinois Jury Finds in Favor of Doctor in Gallbladder Surgery that Led to Fatal Bowel Perforation Nickl v. Barry S. Rosen, M.D. Reoperation for Misplaced Pedicle Screws: A Multicenter Retrospec Pedicle screw placement accuracy impact and comparison between grading 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. 26. Clin Orthop 203:126134, 1986. 2013;34(6):699705. Agarwal N, Gupta R, Agarwal P, et al. 8. Please do not include any confidential or sensitive information in a contact form, text message, or voicemail. Copyright 1944-2023 American Association of Neurological Surgeons, Copy this link, or click below to email it to a friend. The development of the transpedicle screw has provided control of the vertebral motion segment in each plane, resisting any type of load. 2013;123(9):20992103. Cases involving wrong-level or -side surgery, implant malfunction, or other misplaced spinal instrumentation (e.g., interbody cases, rods, surgical instruments, etc.) In addition, hardware failures were observed in 12 patients (10.7%), junctional problems were seen in five patients (4.5%), problems in the instrumented segments were seen in 39 patients (34.7%), and problems of balance occurred in five patients (4.5%). 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). Daniels AH, Ruttiman R, Eltorai AEM, et al. 2016;124(5):15241530. Balch CM, Oreskovich MR, Dyrbye LN, et al. (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. 3. 2014;96(4):266270. Figure 1: Lower thoracic pedicles provide the firm purchase of the pedicle screw from a lateral starting point and 10-15 degrees convergent angle Surgical technique "Free Hand" pedicle screw placement [50] Our "Free Hand" technique is equivalent for lumbar and Rovit RL, Simon AS, Drew J, et al. One hundred twelve consecutive patients were entered into a retrospective study of instrumented thoracolumbar, lumbar, and lumbosacral spinal arthrodesis at our institution, between September 1994 and January 1999. The amount awarded was not significantly different across US regions (p = 0.9; Fig. 2020;162(6):13791387. EOS System Courtesy of EOS imaging. Mohar J, Vali M, Podovovnik E, Mihali R. Eur Spine J. Once the spine is exposed, the appropriate levels of fixation are confirmed with the image intensifier. Methods. Some error has occurred while processing your request. However, only a few complications were related to a poor clinical outcome. Ann R Coll Surg Engl. Potential complications may include increased pain, infection, or mechanical . Clin Orthop 284:8090, 1992. 2018;18(2):209215. 11. These numbers are in line with the current literature. In this example, the surgeon replaced the misplaced screw prior to leaving the operating room, which arguably played a significant role in the jury ruling in favor of the defendant (surgeon).

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