pedicle screw misplacement malpractice30 Ago pedicle screw misplacement malpractice
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. The third surgical procedure removed the pedicle screws but left the patient in an unfused state with an unstable spine. 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. 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. 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. 2. 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. 2021 Jul 1;41(Suppl 1):S80-S86. 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. The medicolegal landscape of spine surgery: how do surgeons fare? 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. Rothberg MB, Class J, Bishop TF, et al. 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. This was followed by pseudarthrosis requiring revision surgery, present in 14.3% (n = 3) and 14.9% (n = 7) of plaintiff- and defendant-awarded cases, respectively (p = 0.99). However, only a few complications were related to a poor clinical outcome. Better strategies need to be devised for evaluation of screw placement, including establishment of a national database of deformity surgery, use of intra-operative image guidance, and reevaluation of postoperative low-dose CT imaging. Eur Spine J. Except for two patients with spinal metastatic disease, all other patients received an iliac crest autologous bone grafts. 2. Using Low-Dose, Biplanar Imaging to Reduce Screw Misplacement 2007;106(6):11081114. Unfortunately, the plaintiffs attorney was unable to offer an alternative theory of surgical negligence that would refute the defendants explanation. This retrospective study analyzes the complications and the problems developed during and after pedicle screw fixation in patients with spinal disorders and trauma. Five patients had uneventful early postoperative course. 7. Spine (Phila Pa 1976). Complications were classified as general, hardware-related, problems associated with the instrumented segments, junctional level problems, and problems related with balance (Table 2). Am J Otolaryngol. pedicle screw: A rigid surgical implant used to stabilize adjacent spinal segments in spinal fusion surgery. Reprint requests to Pavlos Katonis, MD, 99 Minoos & Thenon Street, 71305, Heraklion, Crete, Greece. States were then grouped by US region and case year by 5-year intervals. 11. Schatlo B, Molliqaj G, Cuvinciuc V, et al. It is an effective procedure in that it provides an almost immediate stabilization of the spine [ 2-5 ]. Copyright 2023 Becker's Healthcare. 1. 6. Cookie Policy. 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. Health Aff (Millwood). Continued clinical experience with various pedicle screw implant systems has led to ongoing improvements in system design to minimize implant failure rates and to improve ease of system application. Balch CM, Oreskovich MR, Dyrbye LN, et al. Sarwahi V, Ayan S, Amaral T, Wendolowski S, Gecelter R, Lo Y, Thornhill B. Spine Deform. Clipboard, Search History, and several other advanced features are temporarily unavailable. Spine 18:983991, 1993. In the current study, the arthrodesis rate of 89.4% compares favorably with other previously reported series in the spinal literature, most of which use radiographic means to access the status of the spinal arthrodesis. 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). 2021 Nov;9(6):1541-1548. doi: 10.1007/s43390-021-00377-5. In unstable injuries, the segments above and below the level of injury may have a different orientation of the pedicle trajectory due to . Nahed BV, Babu MA, Smith TR, Heary RF. (PDF) Accuracy of pedicle screw placement in the lumbosacral spine Insuring spinal neurosurgery. Defensive medicine in neurosurgery: the Canadian experience. 2. Fager CA. 1 To be effective, the pedicle screw constructs must withstand intraoperative loading and physiological forces due to daily postoperative activities. There were 74 men and 38 women, with a mean age of 47 years (range, 1872 years). 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. Pedicle screw insertion techniques: an update and review of the Edwards CC: Spinal screw fixation of the lumbar and sacral spine: Early results treating the first 50 cases. Jena AB, Seabury S, Lakdawalla D, Chandra A. In addition, the median time to judgment is substantial, particularly for defendant verdicts, spanning over 4.5 years from the time of surgery. 8,24,25,32. The https:// ensures that you are connecting to the JAMA Intern Med. Personal consequences of malpractice lawsuits on American surgeons. Fortunately, most of the complications were minor and transient. Spine 13:952953, 1988. 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). 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. Using Low-Dose, Biplanar Imaging to Reduce Screw Misplacement. The last two patients had a T12L1 fracture-dislocation and a L4L5 spondylolytic spondylolisthesis at the site of plug dislodgments. reported that 69.3% of neurosurgeons who responded to their survey saw every patient as a potential lawsuit.1. 2014;174(11):18671868. Defendant-awarded cases by US region (right). In addition, seven (6.3%) dural tears occurred during the decompression and none occurred during instrumentation. Harris RI, Wiley JJ: Acquired spondylolysis as a sequel to spine fusion. 2020;11:38. These complications may have resulted from powerful bending movement acting on the screw at its entry point to the bone. Finally, considering the problems of balance, it seems that failure to properly evaluate any preexisting scoliosis was a main cause of this important complication. 2012;89(10):7071. 31. To investigate intraoperative reinsertion of percutaneous pedicle screw (PPS) with intraoperative CT-based navigation and to evaluate the rate of deviation of PPS at postoperative radiographic examination. JAMA. your express consent. Long spine fixation was necessary for patients with tuberculous spondylitis and metastatic disease. General complications were considered those developing during and after surgery that were not directly related to instrumentation. haroinfather roblox id The screws were needed to stabilize the spine and fix the fused vertebrae in place. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. These risks can be minimized by the judicious use of instrumentation by experienced surgeons for specific indications as supported by the literature. This study quantifies the rate of screw misplacement on a per-patient basis to highlight its effect on potential morbidity. Partner, Paul M. da Costa, Obtains $4.5 Million Verdict - Snyder Sarno Clin Orthop 203:7598, 1986. Summary of background data: 20. Spine 8:970981, 1996. In several of the studies in the spinal literature, the contention that instrumentation improves arthrodesis rates, considering that nonunion contributes to a poor outcome in spinal arthrodesis is favored. Scarone P, Vincenzo G, Distefano D, et al. Malpractice litigation and the spine: the NHS perspective on 235 successful claims in England. Epstein NE. Pedicle screw replacement in spinal surgery - The MDU 2012;37(1):6776. Can Postoperative Radiographs Accurately Identify Screw Misplacements? Legal liability in iatrogenic orbital injury. 4. 2021 Nov 26;22(1):986. doi: 10.1186/s12891-021-04860-y. Eur Spine J. The jury found the defendants liable and allocated 75 percent of the fault to Dr. Friedlander and 25 percent to Dr. Bradley. 38. Pedicle screw instrumentation is widely used for the stabilization of the subaxial cervical, thoracic, and lumbar spine. 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.
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