pedicle screw misplacement malpractice

States were then grouped by US region and case year by 5-year intervals. Malpractice risk according to physician specialty. Study supervision: Goodwin, Karikari, Shaffrey, Abd-El-Barr, KD Than. Misplaced pedicle and lateral mass screws result in a considerable risk of malpractice litigation against spine surgeons. Conception and design: Sankey, KD Than. Dr. K. D. Than is a consultant for Bioventus and receives honoraria from DJO and LifeNet Health. Re: malpositioned pedicle screw resulting in additional surgery and disability. 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. Complete degeneration of the upper disc developed in two patients who had spinal stenosis and degenerative scoliosis. 2014;20(6):636643. Each side was judged separately. Fager CA. First, this is a retrospective analysis of cases obtained from the web-based Westlaw Edge legal research database. Thu, May 27th, 2021. Categorical and continuous data are described as frequency (percentage) and median (interquartile range), respectively, except for the use of mean standard deviation for award amounts since both nominal and inflation-adjusted award totals passed (alpha = 0.05) the DAgostino-Pearson omnibus normality test. Finally, considering the problems of balance, it seems that failure to properly evaluate any preexisting scoliosis was a main cause of this important complication. The medicolegal impact of misplaced pedicle and lateral mass screws on [] The accuracy for free-hand screw placement technique varies from 69% to 94%. Malpractice claims in spine surgery in Germany: a 5-year analysis. (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. Statistical analysis: Sankey. Objective: Ann Thorac Surg. Disclosures Dr. Karikari is a consultant for NuVasive, Globus, Johnson & Johnson, and DePuy and receives a spine fellowship fund from NuVasive. In their meta-analysis of nine randomized controlled trials, Li et al. Spine 8:970981, 1996. Dr. K. D. Than is a consultant for Bioventus and receives honoraria from DJO and LifeNet Health. 2019;19(7):12211231. Spine surgery has been disproportionately impacted by medical liability and malpractice litigation, with the majority of claims and payouts related to procedural error. 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. Epstein NE. and transmitted securely. 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. Recently, robot-assisted pedicle screw implantation has been increasingly utilized at large-volume academic centers. Privacy Policy. Dr. Abd-El-Barr is a consultant for Spineology. However, only a few complications were related to a poor clinical outcome. 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. Svider PF, Husain Q, Kovalerchik O, et al. Roy-Camille R, Roy-Camille M, Demeulenaere C: Osteosynthese du rachis dorsal, lombaire et lombo-sacre par plaque metalliques vissees dans les pedicules vertebraux et es apophyses articularies. Facebook Google Plus Youtube RSS Email. 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. The contact form sends information by non-encrypted email, which is not secure. 2011;24(1):1519. MeSH Long spine fixation was necessary for patients with tuberculous spondylitis and metastatic disease. Methods: 2014;96(4):266270. Pedicle screw accuracy in thoracolumbar fractures- is routine postoperative CT scan necessary? 12. Fortunately, most of the complications were minor and transient. A neurologic deficit developed in one patient (0.9%) who had partial bilateral drop feet after reduction of L4L5 spondylolisthesis. Unable to load your collection due to an error, Unable to load your delegates due to an error. Inaccurate pedicle screw placement is relatively common even when placement is performed under fluoroscopic control. 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. Wiltse LL, Spencer CW: New uses and refinements of the paraspinal approach to the lumbar spine. 2014 Sep;21(3):320-8. doi: 10.3171/2014.5.SPINE13567. 2005;293(21):26092617. Clin Orthop 203:7598, 1986. Plaintiff-awarded cases by US region (left). 2017;31(3):287288. 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. Spine 6:263267, 1981. Ultimately, no significant differences were seen in inflation-adjusted award information between plaintiff and defendant (Table 3). FOIA Spine 19:25842589, 1994. 2020;162(6):13791387. Complications and Problems Related to Pedicle Screw Fixation - LWW The plaintiff received $2.4 million for pain and suffering and loss of enjoyment of life, $2 million for lost income and approximately $123,000 for medical expenses. The medicolegal landscape of spine surgery: how do surgeons fare? Sub-analysis of adolescent idiopathic scoliotic patients showed no curve or patient characteristic that correlated with IMP or SAR. The patient had to undergo a subsequent surgery to remove the pedicles. 1 Although this technique has advantages over open instrumentation, it also presents new challenges and specific complications. Cook County Surgeons Cut Common BIle Duct During Surgery, But Jury Finds for Defendants Irwin v. Alan Loren, M.D. Pedicle screw insertion in the thoracolumbar spine. Personal consequences of malpractice lawsuits on American surgeons. 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 After the removal of duplicates, a total of 68 unique cases met our inclusion criteria and were included for analysis. Edwards CC: Spinal screw fixation of the lumbar and sacral spine: Early results treating the first 50 cases. The purpose of current study was to analyze the complications and problems during and after pedicle screw fixation for various spinal disorders and trauma. J Bone Joint Surg 54A:11951204, 1972. Mason A, Paulsen R, Babuska JM, et al. Routine CT scans were taken in all patients. Per-patient analysis showed 23 (18.11%) of patients had all screws AP. 2007;106(6):11081114. 2 One of the first obstacles regarding . We avoid using sharp automated drilling, and probe fully the pedicle cavity to prevent nerve root impairment. 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. 26. 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. McLaughlin WM, Donnelley CA, Yu K, Gillinov SM, Tuason DA. Arthrodesis was questionable in eight asymptomatic patients (7.1%). Risk factor analysis showed smaller Cobb angles increased likelihood of all screws being AP. Rajaee SS, Bae HW, Kanim LE, Delamarter RB. Gertzbein SD, Robbins SE: Accuracy of pedicular screw placement in vivo. Illinois Jury Finds in Favor of Doctor in Gallbladder Surgery that Led to Fatal Bowel Perforation Nickl v. Barry S. Rosen, M.D. 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. 13. Thoracic pedicle screw placement: Free-hand technique - Bioline 21. Unfortunately, the plaintiffs attorney was unable to offer an alternative theory of surgical negligence that would refute the defendants explanation. Cookie Policy. 14. Rynecki ND, Coban D, Gantz O, et al. 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. There were nine instrumentation failures at the thoracolumbar area (seven patients), lumbar area (one patient), and lumbosacral area (one patient). doi: 10.1097/BPO.0000000000001828. Daniels AH, Ruttiman R, Eltorai AEM, et al. Two patients had an acute infection develop for which they required operative intervention with irrigation and debridement. shooting in valdosta leaves one dead Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina; and, Malpractice liability and defensive medicine: a national survey of neurosurgeons, Defensive medicine among high-risk specialist physicians in a volatile malpractice environment, Defensive medicine: a culprit in spiking healthcare costs, Incidence and costs of defensive medicine among orthopedic surgeons in the United States: a national survey study, Defensive medicine in U.S. spine neurosurgery, Personal consequences of malpractice lawsuits on American surgeons. However, the highest offer had been a combined $300,000 from the two defendants. A misplacement rate of more than 20 % (129 misplaced screws out of 608) seems to be unacceptable compared to only 4.5 % misplacements when using CT-navigation leading to the conclusion that pedicle screw instrumentation in the middle and upper thoracic area should be carried out with the help of navigation only. Accuracy of C2 pedicle screw placement using the anatomic freehand Amount awarded to plaintiffs by US region, adjusted for inflation as of April 2020. 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. Crawford MJ, Esses SI: Indications for pedicle fixation: Results of NASS/SRS faculty questionnaire: North American Spine Society and Scoliosis Research Society. Mississippi Appellate Court Affirms Medical Malpractice Defense Verdict 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 Pedicle instrumentation in the thoracolumbar and lumbar spine is a technically challenging procedure. 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. 2018;41(5):e615e620. Litigation resulted in average payouts of $1,204,422 $753,832 between 1995 and 2019, when adjusted for inflation. The average age of the patients was 47 years and the average followup was 35 months. 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. 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. Misplacement rates have been reported to be from 5 to 41% in the lumbar spine and from 3 to 55% in the . 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).

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