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. This occurred on only one side and the correction achieved by the instrumentation was maintained. Agarwal N, Gupta R, Agarwal P, et al. Of note, the award amount for one settlement case was undisclosed. And while the offending screw was removed the next day, Nyquist continued to experience right foot drop, along with lower back pain and sciatica, i.e. Spine 16(8 Suppl):S422427, 1991. Spinal fusion procedures are increasingly performed each year, with Deyo et al. Two patients had early postoperative postural headache that disappeared after removal of the misplaced screw. A CT scan was taken to try and identify the underlying neurological problem that might be causing the new symptom. Deyo RA, Mirza SK, Martin BI. Cerebrospinal fluid fistulas. Pedicle instrumentation in the thoracolumbar and lumbar spine is a technically challenging procedure. Defensive medicine in U.S. spine neurosurgery. The https:// ensures that you are connecting to the Hecht N, Kamphuis M, Czabanka M, et al. They both had motor deficits from which 1 patient recovered completely. Linking and Reprinting Policy. Bookshelf INCLUDE WHEN CITING DOI: 10.3171/2020.8.FOCUS20600. Johnston II CE, Ashman RB, Baird AM, Allard RN: Effect of spinal construct stiffness on early fusion mass incorporation: Experimental study. 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. Patient safety: disclosure of medical errors and risk mitigation, Neurosurgical practice liability: relative risk by procedure type. 16. Plaintiff's expert was prepared to testify at trial that these complaints are characteristic of a malpositioned screw impinging upon a neural structure. Inaccurate pedicle screw placement is relatively common even when placement is performed under fluoroscopic control. 2007;106(6):11081114. Yuan HA, Garfin SR, Dickman CA, Mardjetko SM: A historical cohort study of pedicle screw fixation in thoracic, lumbar and sacral spinal fusions. Spine 6:263267, 1981. Start; O firmie; Usugi; Serwis; Realizacje i porady; Kontakt Guzek RH, Mitchell SL, Krakow AR, Harshavardhana NS, Sarkissian EJ, Flynn JM. This study quantifies the rate of screw misplacement on a per-patient basis to highlight its effect on potential morbidity. FOIA 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 ]. This retrospective study analyzes the complications and the problems developed during and after pedicle screw fixation in patients with spinal disorders and trauma. 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. Neurosurgery. However, the defendant doctor maintained that Nyquists foot drop was not caused by the misplaced screw. Clin Orthop 284:8090, 1992. Among the plaintiff-awarded cases, 13 (61.9%) were decided by jury trial, 7 (33.3%) by settlement, and 1 (4.8%) by arbitration. Two patients had an acute infection develop for which they required operative intervention with irrigation and debridement. Eur Spine J. Reprint requests to Pavlos Katonis, MD, 99 Minoos & Thenon Street, 71305, Heraklion, Crete, Greece. St Louis, CV Mosby 322327, 1987. Administrative/technical/material support: Mehta, Wang, KD Than. Author links open overlay panel Mohamad Bydon a b 1, Dimitrios Mathios a b 1, Mohamed Macki a b, Rafael De la Garza-Ramos a b, Nafi Aygun c, Daniel M. Sciubba a, Timothy F. Witham a, Ziya L. Gokaslan a b, Ali Bydon a b, Jean-Paul Wolinksy a. Introduction. McLaughlin WM, Donnelley CA, Yu K, Gillinov SM, Tuason DA. Studdert DM, Mello MM, Sage WM, et al. 2017 Mar;5(2):109-116. doi: 10.1016/j.jspd.2016.10.007. Clin Orthop 203:4553, 1986. Nyquist had requested the defendants offer, which in retrospect was perhaps a poor decision in light of the Kane County jurys verdict. Cookie Policy. Intraoperative pedicle fractures requiring further points of fixation. With increasing pedicle screw usage, the number of patients with misplaced screws will likely increase proportionally. J Bone Joint Surg 73A:11791184, 1991. 2. Adjusted for age and preoperative Cobb angle, patients with a higher misplacement rate were more likely to have screws . In 2 patients, misplacement of pedicle screws was recognized intraoperatively and all implants were removed. Saillant G: Etude anatomique des pedicules vertebraux: Application chirurgicale. 4. JAMA. This study revealed an overall accuracy rate of 95.2% of mainly percutaneously inserted pedicle screws according to the classification of Zdichavsky et al. 32. 2011;213(5):657667. + 48 696 042 504. 2016;25(3):716723. However, the highest offer had been a combined $300,000 from the two defendants. 37. Per-patient analysis reveals more concerning numbers toward screw misplacement. Moffatt-Bruce SD, Ferdinand FD, Fann JI. Despite commonly used, questions remain about their safety especially for the thoracic spine and in deformity where difficulty in positioning can lead to pedicle breach and adjacent structures injury. Krag MH, Beynnon BD, Pope MH, et al: An internal fixator for posterior application to short segment of the thoracic, lumbar, or lumbosacral spine. Clin Orthop 227:1023, 1988. Thus, we are unable to comment on whether all misplaced screws, particularly when asymptomatic, should be revised in an effort to prevent litigation. In their meta-analysis of nine randomized controlled trials, Li et al. A Cotrel-Dubousset spinal system (Medtronic Sofamor Danek, Memphis, TN) was used in all patients and the total number of screws used was 658. Retrospective analysis of reasons and revision strategy for failed thoracolumbar fracture surgery by posterior approach: a series of 31 cases. The accuracy of pedicle screw placement using intraoperative image guidance systems. Disclaimer. Rothberg MB, Class J, Bishop TF, et al. Clin Orthop 203:717, 1986. laterally placed screws and the azygous vein on the right (T5-T11). Nottmeier EW, Seemer W, Young PM. 1. 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. Several studies have shown that spine surgery is at the highest risk for litigation among the surgical subspecialties.12,29 The majority of claims are related to technical and procedural errors,29 including misplaced pedicle and/or lateral mass screws. 2,24,28,36. Hardware-related failures were observed in 12 patients (10.7%). Copyright © 2023 Becker's Healthcare. The most frequent primary injury listed for a lawsuit was nerve root injury, present in 81.0% (n = 17) and 74.5% (n = 35) of plaintiff- and defendant-awarded cases, respectively (p = 0.7). The intent is to provide relief from pain and nerve damage. It has a great developing technique that is used for fixation and fusion in spine surgery. 2017;31(3):287288. Mukherjee S, Pringle C, Crocker M. A nine-year review of medicolegal claims in neurosurgery. And while the jury debated for about two hours, at the end of its deliberation it sided with the defendants and entered a not guilty verdict. 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. PLoS One. Pediatric pedicle screw placement using intraoperative computed tomography and 3-dimensional image-guided navigation. Instead, the defense offered up an alternative explanation for Nyquists foot drop. In the current study, no incidence of bent and broken screws or tulip screw plug dislodgement necessitated additional treatment, and all the patients achieved solid fusion despite the failure of instrumentation. $ = US$; MW = Midwest; NE = Northeast; SE = Southeast; SW = Southwest; W = West. leg pain. 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. (A) Anteroposterior and (B) lateral radiographs taken 2 years after surgery show unilateral pseudarthrosis in a 55-year-old man with spinal stenosis. Pedicle screw insertions are commonly used for posterior fixation to treat various spine disorders. 2014;20(2):196203. A retrospective review of charts, x-rays (XRs) and computed tomography (CT) scans was performed. 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). Defendant-awarded cases by US region (right). You are talking one of the most complicated area of the law. The defense pointed to the lack of evidence that the screw had ever come into contact with the L5 nerve root. West III JL, Bradford DS, Ogilvie JW: Results of spinal arthrodesis with pedicle screw-plate fixation. 2012;37(1):6776. 2022 Dec;31(12):3544-3550. doi: 10.1007/s00586-022-07427-0. Elizabeth Hofheinz, M.P.H., M.Ed. Dr. Shaffrey holds patents with, receives royalties from, and is a consultant for Medtronic, NuVasive, and Zimmer Biomet; is a stockholder in NuVasive; is a consultant for K2M, Stryker, SI Bone, and In Vivo; and has received grants from the ISSG, DePuy Synthes, and AO Spine. In six patients (5.3%) with degenerative spine disease, the disc material had been removed. 2009;10(1):3339. Characteristics of medicolegal cases related to misplaced screws in spine surgery. 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. The highly litigious environment within healthcare has resulted in a majority of physicians practicing defensive medicine,15 often leading to burnout6,7 and an exorbitant ethical and financial burden on medical and surgical care.7,8 In 2008, medical liability accounted for $55.6 billion, representing 2.4% of the United States (US) healthcare expenditures that year,5,7,9,10 and the pervasive practice of defensive medicine may cost up to $210 billion annually in the US.5 A similar trend has been observed in Europe.11, Neurosurgery is the specialty most frequently affected by lawsuits and the fear of litigation, both in the US and abroad,12 with spine surgery at the forefront.11,1317 As a result, spine surgeons are nearly three times more likely than nonspine surgeons to practice defensive medicine, defined as the avoidance of high-risk procedures and the provision of unnecessary services and assessments beyond what is clinically necessary in an effort to avoid litagation.5 The average time to judgment in a case is approximately 5.1, 5.0, and 3.4 years for defendant verdicts, plaintiff rulings, and settlements, respectively.7,15 As a result, physicians spend an average of 11% of their careers dealing with one or more open malpractice claims.18 Neurosurgeons are especially impacted, spending an average of 27.2% of their careers in an open lawsuit.10. The third surgical procedure removed the pedicle screws but left the patient in an unfused state with an unstable spine. All Rights Reserved. sharing sensitive information, make sure youre on a federal A rod is used to hold the vertebra together to allow fusion to occur. Thirty-five (27.56%) had IMP and 18 (14.17%) had SAR. government site. Waddell G, Kummell EG, Lotto WN, et al: Failed lumbar disc surgery and repeat surgery following industrial injuries. Presse Med 78:14471448, 1970. A large number of studies have reported that in conventional thoracolumbar surgery, compared with traditional freehand screw placement, the accuracy of intraoperative pedicle screw placement has been improved with O-arm intraoperative navigation technology. Steinmann JC, Herkowitz HN: Pseudarthrosis of the spine. 23. Percentage of cases per US region (center). Screws were divided into four categories: screws at risk (SAR), indeterminate misplacements (IMP), benign misplacements (BMP), accurately placed (AP). 2017;27(4):470475. 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. Harris RI, Wiley JJ: Acquired spondylolysis as a sequel to spine fusion. 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. Would you like email updates of new search results? Examples of both laterally and medially misplaced lumbar pedicle screws are provided in Fig. The purpose of current study was to analyze the complications and problems during and after pedicle screw fixation for various spinal disorders and trauma. Li HM, Zhang RJ, Shen CL. 9. 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%). 1). Achieving proper lumbar lordosis, evaluating any preexisting scoliosis, and intraoperative assessment with AP radiographs could prevent balance problems. All Rights Reserved. 2014;75(6):609613. J Neurosurg Spine. Pedicle screws have been used to treat spinal disorders, including those caused by spinal cancer, congenital anomalies, trauma, and chronic pain syndromes. While reported to be one of the best legal research resources available and utilized in several previous studies,7,14,16,23,24 available court documents and clinical/operative details are highly variable and greatly limited among case files. 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 risk according to physician specialty. The amount awarded was not significantly different across US regions (p = 0.9; Fig. In addition, seven (6.3%) dural tears occurred during the decompression and none occurred during instrumentation. Health Aff (Millwood). Pedicle screw placement is a common procedure. Dr. Karikari is a consultant for NuVasive, Globus, Johnson & Johnson, and DePuy and receives a spine fellowship fund from NuVasive. 5. It argued that the foot drop was unavoidable and due to the surgeons need to manipulate the right L5 nerve root in order to remove Nyquists herniated disc during the spinal fusion surgery. The rate of reoperation for screw misplacement per screw was 0.17%. For more information, please refer to our Privacy Policy. Critically revising the article: all authors. 25. Call me tomorrow. 2018;83(5):9971006. However, we did not observe any screw breakage in patients with a degenerative lumbar spine, and the absence of broken screws in this series is because arthrodesis in almost all patients occurred in situ. J Neurosurg Spine. 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. 2012;89(10):7071. Guillain A, Moncany AH, Hamel O, et al. 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. However, the misplacement of pedicle screws can lead to disastrous complications. Whitecloud III TS, Butler JC, Cohen JL, Candelora PD: Complications with the variable spinal plating system. Analysis and interpretation of data: Sankey, TT Than. Sarwahi V, Ayan S, Amaral T, Wendolowski S, Gecelter R, Lo Y, Thornhill B. Spine Deform. J Bone Joint Surg 61A:201207, 1979. Phone/Fax: 30-2810-318361; E-mail: [emailprotected]. 31. Subjects were 10,754 patients (73,777 pedicle screws) who underwent PSF at 11 hospitals over 15 years. 2011;365(7):629636. concluded that the robot-assisted technique was significantly more accurate than the traditional freehand technique.39 Despite the learning curve and initial cost of obtaining technologies such as 3D fluoroscopic devices, intraoperative CT, or robotic navigational systems, the routine use of these technologies for intraoperative imaging confirmation and potential revision of misplaced screws may help spine surgeons avoid inadvertent iatrogenic morbidity for their patients and potential litigation.
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