pedicle screw misplacement malpractice
Defensive medicine: a culprit in spiking healthcare costs. Jury Verdict for Doctor for Screw Allegedly Misplaced During Lumbar In unstable injuries, the segments above and below the level of injury may have a different orientation of the pedicle trajectory due to . An official website of the United States government. Edmunds I, Cummine J, Fearnside M: Prevention of dislodgement of Cotrel-Dubousset rods from tulip screws. These risks can be minimized by the judicious use of instrumentation by experienced surgeons for specific indications as supported by the literature. McAfee PC, Weiland DJ, Carlow JJ: Survivorship analysis of pedicle spinal instrumentation. Spine 15:908912, 1990. Clinical Orthopaedics and Related Research411:86-94, June 2003. Edwards CC: Spinal screw fixation of the lumbar and sacral spine: Early results treating the first 50 cases. Gertzbein SD, Robbins SE: Accuracy of pedicular screw placement in vivo. The accuracy of pedicle screw placement using intraoperative image guidance systems. 2020;45(2):E111E119. Medical malpractice in orthopedic surgery: a Westlaw-based demographic analysis. All the operations were done by one surgeon (PK). Nottmeier EW, Seemer W, Young PM. 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. Pedicle Screw Insertion in Spondylitis Tuberculosis | ORR Am J Orthop. A total of 47 (69.1%) cases resulted in a decision for the defendant and 21 (30.9%) for the plaintiff. Re: malpositioned pedicle screw resulting in additional surgery and disability. The jury found the defendants liable and allocated 75 percent of the fault to Dr. Friedlander and 25 percent to Dr. Bradley. Show more. Dr. Abd-El-Barr is a consultant for Spineology. Spine 19(20 Suppl):2279S2296, 1994. Of the 112 patients, 57 patients had a lumbar degenerative disorder, (lumbar degenerative spinal canal stenosis in 23 patients, degenerative or spondylolytic spondylolisthesis in 12 patients, postlaminectomy instability or stenosis in 20 patients, and recurrent disc prolapse in two patients), 42 patients had spinal cord injury, eight patients had infection, and five patients had a spinal tumor (Table 1). 4. Guzek RH, Mitchell SL, Krakow AR, Harshavardhana NS, Sarkissian EJ, Flynn JM. The rate of reoperation for screw misplacement per screw was 0.17%. Erwin WD, Dickson JH, Harrington PR: Clinical review of patients with broken Harrington rods. Reoperation for Misplaced Pedicle Screws: A Multicenter Retrospec Spine 8:970981, 1996. Federal government websites often end in .gov or .mil. 20th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference, 8th Annual Health IT + Digital Health + RCM Conference, 29th Annual Meeting - The Business & Operations of ASCs, The issues spine surgeons are advocating for outside of the operating room, Centinel Spine is now covered by all major payers, What's next for SI joint fusion? 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. This step in implant evolution was inevitable, because prior phases of implant development did not control each plane of motion segment stress. This study quantifies the rate of screw misplacement on a per-patient basis to highlight its effect on potential morbidity. A total of 2396 screws were placed accurately (87.96%). Please try again soon. Pedicle screw insertion - AO Foundation 2016;102(2):358362. Spine surgery has been disproportionately impacted by medical liability and malpractice litigation, with the majority of claims and payouts related to procedural error. The cost of defensive medicine on 3 hospital medicine services, Defensive medicine in neurosurgery: the Canadian experience, Review of neurosurgery medical professional liability claims in the United States, A nine-year review of medicolegal claims in neurosurgery, Malpractice risk according to physician specialty, Neurosurgical experience with malpractice litigation: an analysis of closed claims against neurosurgeons in New York State, 1999 through 2003, Descriptive analysis of state and federal spine surgery malpractice litigation in the United States, Malpractice litigation following spine surgery, Medical malpractice in orthopedic surgery: a Westlaw-based demographic analysis, Malpractice claims in spine surgery in Germany: a 5-year analysis, On average, physicians spend nearly 11 percent of their 40-year careers with an open, unresolved malpractice claim, Malpractice litigation and the spine: the NHS perspective on 235 successful claims in England, Placement of thoracolumbar pedicle screws using three-dimensional image guidance: experience in a large patient cohort, It is easier to confuse a jury than convince a judge: the crisis in medical malpractice, Determining legal responsibility in otolaryngology: a review of 44 trials since 2008, Legal liability in iatrogenic orbital injury, Spine neurosurgeons facing the judicialization of their profession: disenchantment and alteration of daily practicea qualitative study, Malpractice issues in neurological surgery. Malpositioned pedicle screw resulting | Legal Advice - LawGuru Neurological outcome and management of pedicle screws - PubMed Fortunately, most of the complications were minor and transient. Misplacement rates have been reported to be from 5 to 41% in the lumbar spine and from 3 to 55% in the . 2. As part of the surgery, Dr. Taras Masnyk inserted four metal screws into the plaintiff's spine. Median screw misplacement rate was 10% in group A and 13% in group B. The screws were needed to stabilize the spine and fix the fused vertebrae in place. The majority of plaintiffs were male (n = 44, 64.7%), and the median age among all cases was 46 years (range 3757 years). A retrospective review of charts, x-rays (XRs) and computed tomography (CT) scans was performed. J Neurosurg Spine. Results: 2016;124(5):15241530. Sethi MK, Obremskey WT, Natividad H, et al. Dr. Abd-El-Barr is a consultant for Spineology. Previous biomechanical and clinical studies defining junctional segment problems are lacking and consist mainly of case reports. 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. Spinal fusion procedures are increasingly performed each year, with Deyo et al. Harrington PR, Tullos HS: Reduction of severe spondylolisthesis in children. Spine 13:696706, 1988. 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. Hadjipavlou A, Enker P, Dupuis P, Katzman S, Silver J: The causes of failure of lumbar transpedicular spinal instrumentation and fusion: A prospective study. Int Orthop 20:3542, 1996. 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. 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. Introduction. Achieving proper lumbar lordosis, evaluating any preexisting scoliosis, and intraoperative assessment with AP radiographs could prevent balance problems. West III JL, Bradford DS, Ogilvie JW: Complications of the variable screw pedicle screw fixation. Spine fixation included one segment in 27 patients, two segments in 38 patients, three segments in 42 patients, and more than three segments in five patients. Routine CT scans were taken in all patients. ObjectThe goal of this study was to determine the incidence of screw misplacement and complications in a group of 102 patients who underwent transpedicle screw fixation in the lumbosacral spine with conventional open technique and intraoperative. However, only a few complications were related to a poor clinical outcome. 36. Spine 15:1114, 1990. Spine 16:576579, 1991. Pedicle instrumentation in the thoracolumbar and lumbar spine is a technically challenging procedure. 32. Disc space narrowing was the most common problem after instrumented arthrodesis and was observed in 27 patients (24.1%). 2020;11:38. 2011;306(10):1088. Reprint requests to Pavlos Katonis, MD, 99 Minoos & Thenon Street, 71305, Heraklion, Crete, Greece. JAMA. These complications may have resulted from powerful bending movement acting on the screw at its entry point to the bone. A CT scan was taken to try and identify the underlying neurological problem that might be causing the new symptom. 2014;21(3):320328. 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In two patients in the current series, dislodgement of the rods from tulip screws occurred, as reported originally by Edmunds et al. Dr. K. D. Than is a consultant for Bioventus and receives honoraria from DJO and LifeNet Health. However, the impact of robotic-assisted spinal fusion on patient outcomes is less clear. The standard imaging technique for pedicle screw insertion is two-dimensional images obtained from C-arm-type X-ray fluoroscopy. This site needs JavaScript to work properly. 25. The cost of defensive medicine on 3 hospital medicine services. pedicle screw misplacement malpractice 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. Spine 18:18621866, 1993. 2014;20(2):196203. Incidence and costs of defensive medicine among orthopedic surgeons in the United States: a national survey study. Similar to our findings, prior studies have shown that settlements result in lower payouts than cases that are ultimately taken to trial,7,14,15,30 with awards ranging from $125,000 to $9,000,000 compared to $134,000 to more than $38,000,000.7,15 Nevertheless, the true financial toll on spine surgery is largely unknown given that 85% of cases are dismissed or settled out of court, with undisclosed amounts.14 Likewise, substantial time is spent and costs, including legal and administrative, are incurred before judgment, as noted above. Katonis, Pavlos MD*; Christoforakis, Joseph MD*; Aligizakis, Agisilaos C. MD*; Papadopoulos, Charalampos MD*; Sapkas, George MD, DSc**; Hadjipavlou, Alexander MD*. The case facts centered on a spinal surgery the 34 year-old plaintiff had undergone at Central DuPage Hospital. Ahmadi SA, Sadat H, Scheufler KM, et al. Daniels AH, Ruttiman R, Eltorai AEM, et al. 39. Cerebrospinal fluid fistulas. Mason A, Paulsen R, Babuska JM, et al. Are We Underestimating the Significance of Pedicle Screw Misplacement In addition, hardware failures were observed in 12 patients (10.7%), junctional problems were seen in five patients (4.5%), problems in the instrumented segments were seen in 39 patients (34.7%), and problems of balance occurred in five patients (4.5%). Recently, robot-assisted pedicle screw implantation has been increasingly utilized at large-volume academic centers. I won't be at the office but I will check my voice mail. The initial search using the terms above returned 3654 cases. Patient safety: disclosure of medical errors and risk mitigation, Neurosurgical practice liability: relative risk by procedure type. MeSH Placement of thoracolumbar pedicle screws using three-dimensional image guidance: experience in a large patient cohort. 2013;32(1):111119. However, the misplacement of pedicle screws can lead to disastrous complications. J Neurosurg Spine. A Cotrel-Dubousset spinal system (Medtronic Sofamor Danek, Memphis, TN) was used in all patients and the total number of screws used was 658. Spine J. 2020;162(6):13791387. J Neurosurg Spine. There were 74 men and 38 women, with a mean age of 47 years (range, 1872 years). The rate of misplaced pedicle screws ranges from 1.1% to 28.8%, 10 although neurologic injury from misdirected pedicle screws has been reported to occur in 0% to 12% of patients. Administrative/technical/material support: Mehta, Wang, KD Than. J Neurosurg Spine. 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. Pullout strength of misplaced pedicle screws in the thoracic and lumbar 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. Statistical analysis: Sankey. Objective: 21. Accessibility In patients with degenerative conditions, all of the affected segments were included in the instrumentation and each vertebra was fixed with two pedicle screws. J Am Coll Surg. Quraishi NA, Hammett TC, Todd DB, et al. This patient recovered completely in 6 weeks. 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). Steffee AD, Biscup RS, Sitkowski DJ: Segmental spine plates with pedicle screw fixation: A new internal fixation device for disorders of the lumbar and thoracolumbar spine. 2017;27(4):470475. 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. We serve the following localities: Cook County including Arlington Heights, Barrington, Berwyn Township, Chicago, Des Plaines, Glenview, Orland Park, Palos Park, Schaumburg, and Tinley Park; DuPage County including Downers Grove, Naperville, and Bolingbrook; Kane County including Aurora, Elgin and Geneva; Lake County including Waukegan; and Will County including Joliet. The last two patients had a T12L1 fracture-dislocation and a L4L5 spondylolytic spondylolisthesis at the site of plug dislodgments. 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. 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. Spinal fusion in the United States: analysis of trends from 1998 to 2008. 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). 34. Pedicle screw instrumentation is widely used for the stabilization of the subaxial cervical, thoracic, and lumbar spine. Each side was judged separately. States were then grouped by US region and case year by 5-year intervals. Dr. K. D. Than is a consultant for Bioventus and receives honoraria from DJO and LifeNet Health. The average age of the patients was 47 years and the average followup was 35 months. They both had motor deficits from which 1 patient recovered completely. Wiltse LL, Spencer CW: New uses and refinements of the paraspinal approach to the lumbar spine. 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. The average followup was 35 months (range, 1851 months). SECTION I SYMPOSIUM: Advances in Spine Surgery, Distribution of Spinal Disorders in 112 Patients, Classification of Complications in 64 patients. Some error has occurred while processing your request. Makhni MC, Park PJ, Jimenez J, et al. To prevent general complications, it is evident that precise and careful soft tissue handling, proper irrigation, and debridement during and after surgery, decrease of operative time, and proper patient monitoring postoperatively must be done. Personal consequences of malpractice lawsuits on American surgeons. 9. Study supervision: Goodwin, Karikari, Shaffrey, Abd-El-Barr, KD Than. Safety and efficacy of pedicle screw placement using intraoperative computed tomography: consecutive series of 1148 pedicle screws. Lumbar Spine Surgery. Notwithstanding these concessions, the MDU argued that misplacement of pedicle screw tracts was common in surgery of this kind, even in experienced and competent hands. 1 To be effective, the pedicle screw constructs must withstand intraoperative loading and physiological forces due to daily postoperative activities. Characteristics of medicolegal cases related to misplaced screws in spine surgery. 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. Screws were divided into four categories: screws at risk (SAR), indeterminate misplacements (IMP), benign misplacements (BMP), accurately placed (AP). Disclosures Dr. Karikari is a consultant for NuVasive, Globus, Johnson & Johnson, and DePuy and receives a spine fellowship fund from NuVasive. Likewise, cases are uploaded on a voluntary basis by state and federal judges and courts, which may lead to selection bias. The intent is to provide relief from pain and nerve damage. Don't jump in get legal help. The remaining eight patients, including two patients with spinal trauma, five patients with infection, and one patient with a tumor, had anterior and posterior procedures. A review of medicolegal malpractice suits involving cervical spine: what can we learn or change? 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). Elizabeth Hofheinz, M.P.H., M.Ed. 2022 Jun;8(2):234-241. doi: 10.21037/jss-22-28. 2007;106(6):11081114. Descriptive analysis of state and federal spine surgery malpractice litigation in the United States. In White AH, Rothman RH, Ray CD (eds). Copyright 1944-2023 American Association of Neurological Surgeons, Copy this link, or click below to email it to a friend. A.J. Koktekir E, Ceylan D, Tatarli N, Karabagli H, Recber F, Akdemir G. Spine J. Spine (Phila Pa 1976). 13 Whitecloud et al 35 reported 15% neurologic complications, 5% being caused by incorrect screw placement. 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. Spine (Phila Pa 1976). The plaintiff underwent revision surgery in May 2013. 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 medicolegal landscape of spine surgery: how do surgeons fare? Thoracic Pedicle Screws - ScienceDirect Placement of the pedicle screws in the thoracolumbar and lumbar spine is a technically demanding procedure. However, following the spinal fusion, Nyquist began to experience foot drop in her right foot. Reviewed submitted version of manuscript: all authors. 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. single homes for sale in lehigh valley, pa single homes for sale in lehigh valley, pa Home Realizacje i porady Bez kategorii single homes for sale in lehigh valley, pa Pedicle screw insertion techniques: an update and review of the The total number of reoperations for MPS and patient clinical data were obtained from medical records at each hospital. Spine surgery has been disproportionately impacted by medical liability and malpractice litigation, with the majority of claims and payouts related to procedural error. Segal J. J Spinal Disord Tech. Zdeblick TA: A prospective randomized study of lumbar fusion: Preliminary results. 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. 2 One of the first obstacles regarding . It was firstly introduced by Harrington and Tullos in 1969 and then in late 1980s developed by Roy Camille et al., Louis, and Steffe. Laryngoscope. Privacy Policy. 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. 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. 2014 Sep;21(3):320-8. doi: 10.3171/2014.5.SPINE13567. A TLIF is a surgical procedure that attempts to fuse vertebrae in order to stabilize the patient's spine. Minimizing Pedicle Screw Pullout Risks: A Detailed Biomechan Spine 19:25842589, 1994. Neurosurgical experience with malpractice litigation: an analysis of closed claims against neurosurgeons in New York State, 1999 through 2003.
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