pedicle screw misplacement malpractice

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. J Neurosurg Spine. Mayo Clinic uses the latest robot-assisted technology when indicated to enhance surgical precision in these procedures. Spine 16(8 Suppl):S455458, 1991. In unstable injuries, the segments above and below the level of injury may have a different orientation of the pedicle trajectory due to . Personal consequences of malpractice lawsuits on American surgeons. Safety and accuracy of robot-assisted versus fluoroscopy-guided pedicle screw insertion for degenerative diseases of the lumbar spine: a matched cohort comparison. Inaccurate pedicle screw placement is relatively common even when placement is performed under fluoroscopic control. Spine arthrodesis was evaluated with plain AP and lateral radiographs taken 1 year after surgery. Instead, the defense offered up an alternative explanation for Nyquists foot drop. to maintaining your privacy and will not share your personal information without Jury Verdict for Doctor for Screw Allegedly Misplaced During Lumbar Pullout performance comparison of pedicle screws based on cement application and design parameters Tolga Tolunay, Cemile Bagl, Teyfik Demir, Mesut E Yaman, and Arslan K Arslan Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 2015 229: 11 , 786-793 Download Citation 9. At the lumbosacral area, breakage of a divergent screw of a Chopin block occurred on only one side with no loss of correction. 33. Data is temporarily unavailable. The patient had subsequent coronal imbalance and degeneration of the upper disc. Summary of background data: In four of these patients, bent screws occurred at 8 to 10 months after surgery; in three patients, broken screw necks were seen 1 year after surgery and in two patients, tulip screw plug dislodgments were observed at 4 and 6 months postoperatively, respectively. Critically revising the article: all authors. Bookshelf Median screw misplacement rate was 10% in group A and 13% in group B. 3). shooting in valdosta leaves one dead This demonstrates technical ability but does not represent the impact of screw misplacement on individual patients. Neurosurgery. Misplacement of Pedicle Screws Leads to Years of Pain and Opioid Addiction Surg Neurol. The screws were needed to stabilize the spine and fix the fused vertebrae in place. Using chi square analysis, statistically significant correlation was seen between disc space narrowing and loss of postoperative correction (p < 0.01). Surg Neurol Int. The pedicle screws judged as misplacement. a Medial minor perforation NCI CPTC Antibody Characterization Program. Makhni MC, Park PJ, Jimenez J, et al. 32. pedicle screw misplacement malpractice. 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. Hadjipavlou A, Enker P, Dupuis P, Katzman S, Silver J: The causes of failure of lumbar transpedicular spinal instrumentation and fusion: A prospective study. This patient recovered completely in 6 weeks. Pedicle screw insertions are commonly used for posterior fixation to treat various spine disorders. One hundred four of the 112 patients had a posterior procedure. Disclaimer. Grubb SA, Lipscomb HJ: Results of lumbosacral fusion for degenerative disc disease with and without instrumentation: Two- to five-year follow-up. Bydon M, Xu R, Amin AG, Macki M, Kaloostian P, Sciubba DM, Wolinsky JP, Bydon A, Gokaslan ZL, Witham TF. Schlegel JD, Smith JA, Schleusener RN: Lumbar motion segment pathology adjacent to thoracolumbar, lumbar, and lumbosacral fusions. sharing sensitive information, make sure youre on a federal West III JL, Bradford DS, Ogilvie JW: Results of spinal arthrodesis with pedicle screw-plate fixation. Orthopedics. J Neurosurg Spine. 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. Spine 15:908912, 1990. The initial search using the terms above returned 3654 cases. 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 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. This study quantifies the rate of screw misplacement on a per-patient basis to highlight its effect on potential morbidity. South Med J 62:17, 1969. Med Econ. 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. 2012;37(1):6776. Are We Underestimating the Significance of Pedicle Screw Misplacement It was firstly introduced by Harrington and Tullos in 1969 and then in late 1980s developed by Roy Camille et al., Louis, and Steffe. Ultimately, no significant differences in case demographics were found between plaintiff and defendant judgments (Table 1). Medical malpractice in orthopedic surgery: a Westlaw-based demographic analysis. J Neurosurg Spine. 2020;45(2):E111E119. 26. While the majority of verdicts are found in favor of the defendant (surgeon), over 30% of cases in this study were found in favor of the plaintiff (patient), resulting in average inflation-adjusted payouts of over $1.2 million per claim over the past 25 years. Whitecloud III TS, Butler JC, Cohen JL, Candelora PD: Complications with the variable spinal plating system. A retrospective review of charts, x-rays (XRs) and computed tomography (CT) scans was performed. Eur Spine J. 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. Zdeblick TA: A prospective randomized study of lumbar fusion: Preliminary results. 2007;106(6):11081114. Health Aff (Millwood). 2016;25(3):716723. Quinnell RC, Stockdale HR: Some experimental observations of the influence of a single lumbar floating fusion on the remaining lumbar spine. 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). Dr. Abd-El-Barr is a consultant for Spineology. 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. Dr. Abd-El-Barr is a consultant for Spineology. In addition, seven (6.3%) dural tears occurred during the decompression and none occurred during instrumentation. 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. Descriptive analysis of state and federal spine surgery malpractice litigation in the United States. Thus, meaningful efforts to limit the rate of misplaced pedicle and lateral mass screws, such as the routine use of intraoperative imaging confirmation and/or computer- or robot-assisted navigation, should be carefully considered. Before 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. Routine CT scans were taken in all patients. 2013;123(9):20992103. Complications were classified as general, hardware-related, problems associated with the instrumented segments, junctional level problems, and problems related with balance (Table 2). Overall reported screw misplacement is low, but it does not reflect the potential impact on patient morbidity. A high-low agreement is a settlement in which a defendant agrees to pay the plaintiff a minimum recovery in exchange for the plaintiff agreeing to accept a maximum amount regardless of the trial's outcome. Careers. In the current series, there were no cases of screw misplacement or vascular or neurologic complications caused by implant application. Friedlander and Bradley will pay half of the $2.25 million. Please enable scripts and reload this page. Epstein NE. Malpractice risk according to physician specialty. 2022 Sep 15;14(9):6323-6331. eCollection 2022. Katonis, Pavlos MD*; Christoforakis, Joseph MD*; Aligizakis, Agisilaos C. MD*; Papadopoulos, Charalampos MD*; Sapkas, George MD, DSc**; Hadjipavlou, Alexander MD*. Three slender patients complained of soft tissue irritation and a bothersome prominence because of the screws bulky profile. Clin Orthop 284:8090, 1992. Pedicle instrumentation in the thoracolumbar and lumbar spine is a technically challenging procedure. N Engl J Med. Jena AB, Seabury S, Lakdawalla D, Chandra A. Spine 16(8 Suppl):S422427, 1991. Cerebrospinal fluid fistulas. Screws penetrating the anterior cortex and abutting vascular structures, particularly aortic abutment with left-sided screws, which can lead to erosion and pseudoaneurysms. 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. Of note, the award amount for one settlement case was undisclosed.

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