Defensive medicine in U.S. spine neurosurgery. This demonstrates technical ability but does not represent the impact of screw misplacement on individual patients.
The medicolegal impact of misplaced pedicle and lateral mass screws on $ = US$; MW = Midwest; NE = Northeast; SE = Southeast; SW = Southwest; W = West. 8,24,25,32. Spine 16(8 Suppl):S422427, 1991. Defensive medicine in neurosurgery: the Canadian experience. Spine 16(8 Suppl):S455458, 1991. A.J. 17,18,31,39 Edwards 6 showed that solid arthrodesis developed in 96% of patients without previous surgery, whereas 84% of patients having secondary operations experienced a similar result. Spine 19(20 Suppl):2279S2296, 1994. Subjects were 10,754 patients (73,777 pedicle screws) who underwent PSF at 11 hospitals over 15 years. Intraoperative pedicle fractures requiring further points of fixation. A review of medicolegal malpractice suits involving cervical spine: what can we learn or change? Plaintiff's expert was prepared to testify at trial that these complaints are characteristic of a malpositioned screw impinging upon a neural structure.
Robotic-assisted pedicle screw placement fails to reduce overall Both of these patients complained of thigh pain but refused any additional surgery.
CT-navigation versus fluoroscopy-guided placement of pedicle screws at 26. 2020;11:38. Erwin WD, Dickson JH, Harrington PR: Clinical review of patients with broken Harrington rods. Spine 6:263267, 1981. leg pain.
Pedicle screw | definition of pedicle screw by Medical dictionary Previous biomechanical and clinical studies defining junctional segment problems are lacking and consist mainly of case reports. 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. The medicolegal landscape of spine surgery: how do surgeons fare? 1.
Partner, Paul M. da Costa, Obtains $4.5 Million Verdict - Snyder Sarno Aigner R, Bichlmaier C, Oberkircher L, Knauf T, Knig A, Lechler P, Ruchholtz S, Frink M. BMC Musculoskelet Disord. Misplaced pedicle and lateral mass screws result in a considerable risk of malpractice litigation against spine surgeons. McAfee PC, Weiland DJ, Carlow JJ: Survivorship analysis of pedicle spinal instrumentation. 2012;41(2):6973. All Rights Reserved. However, the misplacement of pedicle screws can lead to disastrous complications. J Spine Surg.
Reoperation for Misplaced Pedicle Screws: A Multicenter Retrospec Before 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. Overall reported screw misplacement is low, but it does not reflect the potential impact on patient morbidity. The .gov means its official. Clin Orthop 203:717, 1986. Katonis, Pavlos MD*; Christoforakis, Joseph MD*; Aligizakis, Agisilaos C. MD*; Papadopoulos, Charalampos MD*; Sapkas, George MD, DSc**; Hadjipavlou, Alexander MD*. The average followup was 35 months (range, 1851 months). Adjusted for age and preoperative Cobb angle, patients with a higher misplacement rate were more likely to have screws . 3. 15. 2. 2014;20(6):636643. However, only a few complications were related to a poor clinical outcome. 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. 2. 31. 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. Hadjipavlou A, Enker P, Dupuis P, Katzman S, Silver J: The causes of failure of lumbar transpedicular spinal instrumentation and fusion: A prospective study. Although the rate of the reported complications was high, the final outcome of the patients was not affected significantly. Each side was judged separately. Spine 16:576579, 1991. Copyright 1944-2023 American Association of Neurological Surgeons, Copy this link, or click below to email it to a friend. However, this is the first study to evaluate the direct medicolegal impact of misplaced pedicle and lateral mass screws on spine surgery in the US and presents important information that may support the routine use of intraoperative imaging confirmation (via 3D fluoroscopy or intraoperative CT) and/or navigated screw placement (either computer- or robot-assisted) as a potential method to decrease the risk of future litigation during spinal fusion procedures. This retrospective study analyzes the complications and the problems developed during and after pedicle screw fixation in patients with spinal disorders and trauma. Plaintiff-awarded cases by US region (left). The physician ordered an MRI of the lumbar spine which showed that the screws had been misplaced and were puncturing the patient's lumbar nerves. JAMA. 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. The jury found the defendants liable and allocated 75 percent of the fault to Dr. Friedlander and 25 percent to Dr. Bradley. 14. Rajasekaran S, Bhushan M, Aiyer S, et al. In the Kane County medical malpractice lawsuit of Melissa Nyquist v. Dr. Taras Masnyk and DuPage Neurosurgery, S.C., 06 L 421, the plaintiffs attorney was unable to convince the jury that the plaintiffs medical complications were caused by the defendants negligence. Clinical Orthopaedics and Related Research411:86-94, June 2003. 35. Quraishi NA, Hammett TC, Todd DB, et al. J Neurosurg Spine. Once the spine is exposed, the appropriate levels of fixation are confirmed with the image intensifier. Br J Neurosurg. Harrington and Tullos 11 first reported the technique of transpedicle screw fixation, and Roy-Camille et al 23 popularized the first practical method of pedicle screw fixation. For more information, please refer to our Privacy Policy. Epub 2022 Oct 29. 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. Pedicle screw placement accuracy using ultra-low radiation imaging with image enhancement versus conventional fluoroscopy in minimally invasive transforaminal lumbar interbody fusion: an internally randomized controlled trial. Nottmeier EW, Seemer W, Young PM. Svider PF, Kovalerchik O, Mauro AC, et al.
(PDF) Accuracy of pedicle screw placement in the lumbosacral spine Yuan et al 37 reported that the use of spinal instrumentation is associated with higher rate of infection (3%6%), neurologic injury (1%5%), instrumentation failure (6%10%), and reoperation (20%), compared with in situ arthrodeses. A review of medicolegal malpractice suits involving cervical spine: what can we learn or change? Routine CT scans were taken in all patients. * Elsamadicy AA, Sergesketter AR, Frakes MD, Lad SP.
70% of Pedicle Screws are misplaced - orthostreams.com Legal liability in iatrogenic orbital injury. Ultimately, no significant differences were seen in inflation-adjusted award information between plaintiff and defendant (Table 3). 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. Pedicle screw fixation is an effective but demanding method to treat various spinal disorders and is associated with a significant complication rate. The patient suffered permanent nerve damage as a result of the puncture.
Delayed open treatment of aortic penetration by a thoracic pedicle 3. 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. 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). 1 Although this technique has advantages over open instrumentation, it also presents new challenges and specific complications. Malpractice risk according to physician specialty. The defense pointed to the lack of evidence that the screw had ever come into contact with the L5 nerve root. Study design: Edmunds I, Cummine J, Fearnside M: Prevention of dislodgement of Cotrel-Dubousset rods from tulip screws.
Risk Factors for the Drift Phenomenon in Oarm NavigationAssisted pedicle screw: A rigid surgical implant used to stabilize adjacent spinal segments in spinal fusion surgery. Retrospective analysis of reasons and revision strategy for failed thoracolumbar fracture surgery by posterior approach: a series of 31 cases. In situ spine arthrodesis permits load sharing by the vertebral bodies, preventing fatigue failure of the implant. 13 Whitecloud et al 35 reported 15% neurologic complications, 5% being caused by incorrect screw placement. 2012;7(6):e39237. Balch CM, Oreskovich MR, Dyrbye LN, et al. Bethesda, MD 20894, Web Policies Characteristics of medicolegal cases related to misplaced screws in spine surgery. 5. Steinmann JC, Herkowitz HN: Pseudarthrosis of the spine. Rather, the defense demonstrated that although the misplaced screw had in fact irritated the L4 nerve root for the six days before it was removed, the related symptoms resolved with the screws removal. The incidence of screw failure, which can occur despite solid arthrodesis, 7 in the current series was 8% and mainly involved patients with thoracolumbar injury.
Pullout performance comparison of pedicle screws based on cement Rovit RL, Simon AS, Drew J, et al. laterally placed screws and the azygous vein on the right (T5-T11).
2016;102(2):358362. Grubb SA, Lipscomb HJ: Results of lumbosacral fusion for degenerative disc disease with and without instrumentation: Two- to five-year follow-up. The instrumentation and bone graft were left in place in these patients (total infection rate, 2.7%). Dalenberg DD, Asher MA, Robinson RG, Jayaraman G: The effect of a stiff spinal implant and its loosening on bone mineral content in canines. 2011;24(1):1519. shooting in valdosta leaves one dead Long spine fixation was necessary for patients with tuberculous spondylitis and metastatic disease. 8. Federal government websites often end in .gov or .mil.
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