A p < 0.05 was considered statistically significant. 37. 30. Disc space narrowing was the most common problem after instrumented arthrodesis and was observed in 27 patients (24.1%). However, the misplacement of pedicle screws can lead to disastrous complications because of the close proximity to neural tissue and the surrounding vessels, although rare, serious complications have been reported, such as dural tear, nerve-root irritation, neural injury . Dr. Shaffrey has received grants from the NIH and Department of Defense. The medical malpractice suit Ayala v. Friedlander, M.D., claimed that a March 2011 lumbar fusion surgery performed by neurosurgeon Marvin Friedlander, MD, and orthopedic spine surgeon Douglas Bradley, MD, strayed from the accepted standards of care because a pedicle screw was placed in the wrong location. Can Postoperative Radiographs Accurately Identify Screw Misplacements? Screw misplacement. The screws were needed to stabilize the spine and fix the fused vertebrae in place. Clin Orthop 203:4553, 1986. The third patient, who had central spinal stenosis, was treated by decompression alone. 2011;213(5):657667. Autor de la entrada Por ; Fecha de la entrada austin brown musician; matrix toners for bleached hair . Call Us Now For a Free Consultation | Toll Free: 800.583.8002 | Local: 312.346.0045, Cook County Surgeons Cut Common BIle Duct During Surgery, But Jury Finds for Defendants , Illinois Jury Finds in Favor of Doctor in Gallbladder Surgery that Led to Fatal Bowel Perforation , Debate Over Extent of Eye Damage Following Implant Lens Surgery Leads to $1 Million Verdict in, $75 Million Jury Verdict in Failure to Timely Diagnose Stroke, $18 Million Jury Verdict in Late Diagnosis of Breast Cancer, $300,000 Settlement for Excessive Use of Radiation, Chicago Medical Malpractice Lawyer Kreisman Law Offices Home, Contact Illinois Personal Injury Attorney Kreisman Law Offices. 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. 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). 8600 Rockville Pike 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 Are We Underestimating the Significance of Pedicle Screw Misplacement A total of 2724 screws were placed in 127 patients. However, the misplacement of pedicle screws can lead to disastrous complications. Statistical analysis: Sankey. (A) Anteroposterior and (B) lateral radiographs taken 1 year after surgery show upper screw breakage in the application of a short Cotrel-Dubousset construct in a T12 burst fracture. 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). 2017;31(3):287288. Rajaee SS, Bae HW, Kanim LE, Delamarter RB. to maintaining your privacy and will not share your personal information without Complications were classified as general, hardware-related, problems associated with the instrumented segments, junctional level problems, and problems related with balance (Table 2). Despite these failures, solid spinal arthrodesis was obtained in all patients. Unfortunately, the plaintiffs attorney was unable to offer an alternative theory of surgical negligence that would refute the defendants explanation. J Neurosurg Spine. 13 Whitecloud et al 35 reported 15% neurologic complications, 5% being caused by incorrect screw placement. Zdeblick TA: A prospective randomized study of lumbar fusion: Preliminary results. The remaining two patients had asymptomatic junctional problems develop after two- and three-segment fusions, at the third and fourth postoperative year, respectively. Guillain A, Moncany AH, Hamel O, et al. The majority of screws were misplaced in the lumbar spine for both plaintiff- and defendant-awarded cases (66.7% vs 57.4%, respectively, p = 0.564; Table 1). Am J Transl Res. Except for the patient with an infected pseudarthrosis who had a flat back syndrome (sagittal imbalance) develop, coronal imbalance was observed in five patients (4.5%), and ranged from 7.5 to 12 (Fig 3). Whitecloud III TS, Butler JC, Cohen JL, Candelora PD: Complications with the variable spinal plating system. The third surgical procedure removed the pedicle screws but left the patient in an unfused state with an unstable spine. leg pain. 2012;41(2):6973. Dr. Goodwin has received grants from the Burroughs Wellcome Fund, North Carolina Spine Society, and Robert Wood Johnson Harold Amos Medical Faculty Development Program and the NIH/NINDS K12 NRCDP Physician Scientist Award. 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. 22. Subjects were 10,754 patients (73,777 pedicle screws) who underwent PSF at 11 hospitals over 15 years. A retrospective review of closed medicolegal cases with verdicts or settlements between 1995 and 2019 was performed using the Westlaw Edge legal research database (Thomson Reuters).7,14,16,23,24 A search of closed federal and state malpractice claims within the Verdicts and Settlements section consisted of the following: spine and surgery and pedicle and screw and fusion and (misplaced or misguided or mispositioned) and surgeon. Inclusion criteria consisted of malpractice claims against surgeons for complications related to misplaced pedicle and/or lateral mass screws. Spine 13:10121018, 1988. 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. 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. I won't be at the office but I will check my voice mail. were excluded from analysis. (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. In situ spine arthrodesis permits load sharing by the vertebral bodies, preventing fatigue failure of the implant. 2012 Feb 1;37(3):E188-94. Malpractice issues in neurological surgery. Thu, May 27th, 2021. 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. In their meta-analysis of nine randomized controlled trials, Li et al. Three-dimensional printing versus freehand surgical techniques in the surgical management of adolescent idiopathic spinal deformity. 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. Misplacement of Pedicle Screws Leads to Years of Pain and Opioid Addiction 6. HHS Vulnerability Disclosure, Help Forty-seven general complications were seen in 41 patients (36.5%). 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. It should be used by experienced and qualified surgeons who are familiar with the pitfalls associated with its use. 4. 26 They support that after a lengthy symptom-free period, segments next to a fused segment can break down and the segment next to the adjacent segment is almost as likely to break down as the adjacent segment. Friedlander and Bradley will pay half of the $2.25 million. Would you like email updates of new search results? 2020;162(6):13791387. J Neurosurg Spine. 2,24,28,36. The screws were needed to stabilize the spine and fix the fused vertebrae in place. This study revealed an overall accuracy rate of 95.2% of mainly percutaneously inserted pedicle screws according to the classification of Zdichavsky et al. Neurosurgery. 0 attorneys agreed. Safety and efficacy of pedicle screw placement using intraoperative computed tomography: consecutive series of 1148 pedicle screws. However, published reports are increasingly demonstrative of the positive effect of pedicle fixation on arthrodesis and successful outcome in the treatment of patients with these disorders. Of note, the award amount for one settlement case was undisclosed. pedicle screw misplacement malpractice Spinal fusion in the United States: analysis of trends from 1998 to 2008. 1 Although this technique has advantages over open instrumentation, it also presents new challenges and specific complications. It is easier to confuse a jury than convince a judge: the crisis in medical malpractice. Characteristics of medicolegal cases related to misplaced screws in spine surgery. Pedicle screw insertions are commonly used for posterior fixation to treat various spine disorders. Cerebrospinal fluid fistulas. 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. 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. All Rights Reserved. Abstract BACKGROUND CONTEXT Surgeons have increasingly adopted robotic-assisted lumbar spinal fusion due to indications that robotic-assisted surgery can reduce pedicle screw misplacement. This device was used with an early version of the Cotrel-Dubousset instrumentation to provide sacral fixation and it is rarely used since the more widespread use of newer spine fixation systems. 2013;34(6):699705. PURPOSE This study aimed to compare rates of perioperative complications between robotic-assisted and conventional . Pedicle screw placement: Robotic assistance for greater precision Am J Orthop. Personal consequences of malpractice lawsuits on American surgeons. The medicolegal impact of misplaced pedicle and lateral mass screws on 2. Hecht N, Kamphuis M, Czabanka M, et al. 4. Seven hundred sixty-three screws were inserted in 138 patients. Neurosurgical practice liability: relative risk by procedure type. Hardware-related failures were observed in 12 patients (10.7%). These risks can be minimized by the judicious use of instrumentation by experienced surgeons for specific indications as supported by the literature. Results: A total of 2724 screws were placed in 127 patients. Once the spine is exposed, the appropriate levels of fixation are confirmed with the image intensifier. 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. South Med J 62:17, 1969. 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. This occurred on only one side and the correction achieved by the instrumentation was maintained. Defensive medicine in U.S. spine neurosurgery. States were then grouped by US region and case year by 5-year intervals. Dr. K. D. Than is a consultant for Bioventus and receives honoraria from DJO and LifeNet Health. One common area for the potential avoidance of malpractice claims and subsequent payouts involves misplaced pedicle and/or lateral mass instrumentation. 17. Agarwal N, Gupta R, Agarwal P, et al. Robotic-assisted pedicle screw placement fails to reduce overall Litigation resulted in average payouts of $1,204,422 $753,832 between 1995 and 2019, when adjusted for inflation. Krag MH, Beynnon BD, Pope MH, et al: An internal fixator for posterior application to short segment of the thoracic, lumbar, or lumbosacral spine. Quinnell RC, Stockdale HR: Some experimental observations of the influence of a single lumbar floating fusion on the remaining lumbar spine. Int Orthop 20:3542, 1996. J Bone Joint Surg 62A:13021307, 1980. Several limitations should be carefully considered when interpreting our results. The patient had to undergo a subsequent surgery to remove the pedicles. They both had motor deficits from which 1 patient recovered completely. Spine surgery has been disproportionately impacted by medical liability and malpractice litigation, with the majority of claims and payouts related to procedural error. In the current series, including general complications, only 48 patients (43%) had no notable complication and the remaining 64 patients (57%) had one or more complications. Over 40% of patients had screws with either some/major concern. Jury Verdict for Doctor for Screw Allegedly Misplaced During Lumbar All case demographics are summarized in Table 1. In our opinion, these problems may be prevented by applying the following principles: limitation of spine arthrodesis to the pathologic levels, inclusion of already extensive changes at the level above or below the planned arthrodesis into the arthrodesis, restoration of postoperative sagittal and coronal alignment, and avoidance of impingement syndrome from the adjacent nonfused facets. Patient-specific 3D-printed surgical guides for pedicle screw insertion Study design: Johnston II CE, Ashman RB, Baird AM, Allard RN: Effect of spinal construct stiffness on early fusion mass incorporation: Experimental study. Nayar G, Blizzard DJ, Wang TY, et al. Screws penetrating the anterior cortex and abutting vascular structures, particularly aortic abutment with left-sided screws, which can lead to erosion and pseudoaneurysms. Melissa Nyquist required a lumbar back fusion for a herniated disc at the L4-5 level. Operative information including fusion level, number of levels fused, level of misplaced screw(s), single versus multiple misplaced screw(s), presence of known CSF leakage, and primary injury due to screw misplacement was also collected. On average, physicians spend nearly 11 percent of their 40-year careers with an open, unresolved malpractice claim. 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. Dr. Karikari is a consultant for NuVasive, Globus, Johnson & Johnson, and DePuy and receives a spine fellowship fund from NuVasive. Sethi MK, Obremskey WT, Natividad H, et al. CT-navigation versus fluoroscopy-guided placement of pedicle screws at Screws were divided into four categories: screws at risk (SAR), indeterminate misplacements (IMP), benign misplacements (BMP), accurately placed (AP). We serve the following localities: Cook County including Arlington Heights, Barrington, Berwyn Township, Chicago, Des Plaines, Glenview, Orland Park, Palos Park, Schaumburg, and Tinley Park; DuPage County including Downers Grove, Naperville, and Bolingbrook; Kane County including Aurora, Elgin and Geneva; Lake County including Waukegan; and Will County including Joliet. Patient safety: disclosure of medical errors and risk mitigation. (%), Pseudarthrosis requiring revision surgery. Comparetto, Esq., 727-328-7900, www.florida-malpractice-lawyers.com. reported that 69.3% of neurosurgeons who responded to their survey saw every patient as a potential lawsuit.1. Copyright 1944-2023 American Association of Neurological Surgeons, Copy this link, or click below to email it to a friend. McLaughlin WM, Donnelley CA, Yu K, Gillinov SM, Tuason DA. 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. 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. 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%). The states with the most cases included California (n = 10, 14.7%), New York (n = 6, 8.8%), Pennsylvania (n = 6, 8.8%), and Illinois (n = 5, 7.3%; Table 2). Cook County Surgeons Cut Common BIle Duct During Surgery, But Jury Finds for Defendants Irwin v. Alan Loren, M.D. pedicle screw misplacement malpractice. Misplaced pedicle and lateral mass screws result in a considerable risk of malpractice litigation against spine surgeons. Katonis, Pavlos MD*; Christoforakis, Joseph MD*; Aligizakis, Agisilaos C. MD*; Papadopoulos, Charalampos MD*; Sapkas, George MD, DSc**; Hadjipavlou, Alexander MD*. 31. We avoid using sharp automated drilling, and probe fully the pedicle cavity to prevent nerve root impairment. The standard imaging technique for pedicle screw insertion is two-dimensional images obtained from C-arm-type X-ray fluoroscopy. 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. haroinfather roblox id Defendant-awarded cases by US region (right). To prevent the development of pseudarthrosis, we think it is important for surgeons to apply the following five technical principles: the proper-sized pedicle screw has to be inserted on the first attempt; repeated manipulation in setting instruments must be avoided; anterior penetration of the screw into the sacrum and insertion of two screws in each side are advocated for fixing the lumbosacral junction; industrious and detailed decortication of the posterior elements must be developed fully; and the use of autologous bone graft is recommended. Pedicle screws are used by spine surgeons as part of a fusion in which two adjacent bones in the spine are combined together as one. Elizabeth Hofheinz, M.P.H., M.Ed. Thoracic pedicle screw placement: Free-hand technique - Bioline 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.