pedicle screw misplacement malpractice

Ultimately, additional prospective, multiinstitutional large-volume studies are needed to validate these findings, and future studies should evaluate the long-term impact on the routine use of intraoperative imaging confirmation and/or computer- or robot-assisted navigation on the frequency and success of malpractice claims related to misplaced pedicle and lateral mass screws. 2018;41(5):e615e620. 4. The instrumentation and bone graft were left in place in these patients (total infection rate, 2.7%). were excluded from analysis. Spine surgery has been disproportionately impacted by medical liability and malpractice litigation, with the majority of claims and payouts related to procedural error. 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. 2014 Aug 1;14(8):1702-8. doi: 10.1016/j.spinee.2014.03.044. 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. Krag MH, Beynnon BD, Pope MH, et al: An internal fixator for posterior application to short segment of the thoracic, lumbar, or lumbosacral spine. Hardware problems were those related to the physical change of metal and screw position. 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. Bydon M, Xu R, Amin AG, Macki M, Kaloostian P, Sciubba DM, Wolinsky JP, Bydon A, Gokaslan ZL, Witham TF. I won't be at the office but I will check my voice mail. Pedicle screw insertions are commonly used for posterior fixation to treat various spine disorders. 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. Examples of both laterally and medially misplaced lumbar pedicle screws are provided in Fig. Svider PF, Husain Q, Kovalerchik O, et al. Spine (Phila Pa 1976). J Bone Joint Surg 54A:11951204, 1972. Pitfall: Unstable injuries. The median time to case closure was longer for defendant-awarded cases, but this finding was not statistically significant (61.5 vs 56.3 months, p > 0.05). 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. Malpractice litigation following spine surgery. As compared to cases in 19952009, those in 20102019 resulted in a significantly higher average nominal payout to plaintiffs ($776,439 $74,460 vs $1,506,000 $385,527, p = 0.028). Fishers exact test and the Mann-Whitney U-test were used for the analysis of categorical and continuous data, respectively, except when an unpaired t-test was utilized for analyses related to normalized, nominal, and inflation-adjusted award totals. Spinal fusion in the United States: analysis of trends from 1998 to 2008. 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. Roy-Camille R, Saillant G, Mazel C: Internal fixation of the lumbar spine with pedicle screw plating. Spine J. Feb. 16, 2021 Accurate placement of pedicle screws is key to avoiding the potential complications of spinal fusion surgery and improving overall spinal fixation. A retrospective review of charts, XRs and low-dose CT scans of 127 patients who underwent spinal fusion with pedicle screws for spinal deformity was performed. Spine 19(20 Suppl):2279S2296, 1994. 2013;34(6):699705. Wolters Kluwer Health Hardware-related failures were observed in 12 patients (10.7%). Each side was judged separately. The remaining two patients had asymptomatic junctional problems develop after two- and three-segment fusions, at the third and fourth postoperative year, respectively. Arthrodesis was questionable in eight asymptomatic patients (7.1%). Spine 18:18621866, 1993. Background The objective of this cadaveric study was to analyze the effects of iatrogenic pedicle perforations from screw misplacement on the mean pullout strength of lower thoracic and lumbar pedicle screws. 4). Schatlo B, Molliqaj G, Cuvinciuc V, et al. Although the rate of the reported complications was high, the final outcome of the patients was not affected significantly. J Am Coll Surg. 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. Pedicle screw insertions are commonly used for posterior fixation to treat various spine disorders. 5-7 Materials and Methods This is a retrospective study of kyphotic spondylitis tuberculosis (Stb) patients conducted at Fatmawati General Hospital, Jakarta, Indonesia, through the year 2020-2021. Malpositioned pedicle screw resulting | Legal Advice - LawGuru 2013;32(1):111119. Conversely, Nyquists foot drop did not resolve after the screw was removed, which begged the question of whether the foot drop was in fact caused by the misplaced screw. Similarly, the highest inflation-adjusted amount awarded ($2,302,472) for pseudarthrosis was attributed to a medially breached pedicle screw during an L5S1 fusion that was determined to have caused the failed union and subsequent need for revision surgery. 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. Of note, the award amount for one settlement case was undisclosed. 3). Long spine fixation was necessary for patients with tuberculous spondylitis and metastatic disease. True accuracy of percutaneous pedicle screw placement in thoracic and 2018;29(4):397406. 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). Whitecloud III TS, Butler JC, Cohen JL, Candelora PD: Complications with the variable spinal plating system. There were two complete degenerations of the upper disc, one central canal stenosis, and two asymptomatic disc space narrowings and retrolistheses. Error in trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. N Engl J Med. Am J Transl Res. Spine 18:983991, 1993. Risk Factors for the Drift Phenomenon in Oarm NavigationAssisted The medicolegal landscape of spine surgery: how do surgeons fare? Neurosurgical experience with malpractice litigation: an analysis of closed claims against neurosurgeons in New York State, 1999 through 2003. 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. 2012 Feb 1;37(3):E188-94. You are talking one of the most complicated area of the law. Spine 13:10121018, 1988. Accuracy and workflow of navigated spinal instrumentation with the mobile AIRO CT scanner. In six of these patients with injuries at the thoracolumbar area (four patients with bent screws and two patients with broken screws), the loss of correction ranged from 3 to 4.5 without change of anatomic reduction (Fig 1). Balch CM, Oreskovich MR, Dyrbye LN, et al. Dr. Shaffrey has received grants from the NIH and Department of Defense. Lumbosacral pedicle screw placement using a fluoroscopic pedicle axis Most of these complications were minor and with the exception of two misplaced screws, did not contribute to the occurrence of neurologic impairment or severe pain. Pedicle screw accuracy in thoracolumbar fractures- is routine postoperative CT scan necessary? 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%. Although the rationale for using pedicle screw fixation is fairly clear, controversy continues regarding the application of pedicle instrumentation for spine arthrodesis, especially on the degenerative lumbar spine. The majority of plaintiffs were male (n = 44, 64.7%), and the median age among all cases was 46 years (range 3757 years). Clin Orthop 203:7598, 1986. Illinois Jury Finds in Favor of Doctor in Gallbladder Surgery that Led to Fatal Bowel Perforation Nickl v. Barry S. Rosen, M.D. Am J Orthop. Delayed open treatment of aortic penetration by a thoracic pedicle At the trials close, the plaintiffs attorney had asked the jury to return a $5.3 million verdict and had made a prior demand to settle the medical malpractice lawsuit for $1 million. 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. Mean amounts awarded SD to plaintiffs by jury trial (n = 13) versus settlement/arbitration (n = 7), adjusted for inflation as of April 2020. 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 Moffatt-Bruce SD, Ferdinand FD, Fann JI. $2 Million Spinal Surgery Case Against Neurosurgeon and Hospital One hundred four of the 112 patients had a posterior procedure. Quinnell RC, Stockdale HR: Some experimental observations of the influence of a single lumbar floating fusion on the remaining lumbar spine. One hundred twelve patients were treated using the Cotrel-Dubousset pedicle screw fixation system for degenerative disease (57 patients), trauma (42 patients), infection (eight patients), and tumor (five patients) of the lumbar or thoracolumbar spine. Malpractice issues in neurological surgery. It is indicated that screws medially misplaced at a distance greater than 2-mm, especially 4 mm, may be a cause of negative effects on the neural structure and should be removed during the early phase of the postoperative period, even among patients without postoperative neurological abnormalities. Under the high-low agreement, Drs. Neurosurgery. Drs. Insuring spinal neurosurgery. Clin Orthop 203:717, 1986. Recently, robot-assisted pedicle screw implantation has been increasingly utilized at large-volume academic centers. Dr. K. D. Than is a consultant for Bioventus and receives honoraria from DJO and LifeNet Health. leg pain. Complications were classified as general, hardware-related, problems associated with the instrumented segments, junctional level problems, and problems related with balance (Table 2). Brodsky AE: Post-laminectomy and post-fusion stenosis of the lumbar spine. Using Low-Dose, Biplanar Imaging to Reduce Screw Misplacement PMC 34. The case facts centered on a spinal surgery the 34 year-old plaintiff had undergone at Central DuPage Hospital. Friedlander and Bradley will pay half of the $2.25 million. [] Computer-assisted computed tomography (CT) techniques have improved the overall accuracy for pedicle screw placement, and has reduced complication rates. 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. Rothberg MB, Class J, Bishop TF, et al. To evaluate the accuracy of pedicle screw placement using a novel classification system to determine potentially significant screw misplacement. 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. 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.

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