2018;29(4):397406. Malpractice issues in neurological surgery. Operative information including fusion level, number of levels fused, level of misplaced screw(s), single versus multiple misplaced screw(s), presence of known CSF leakage, and primary injury due to screw misplacement was also collected. Clin Orthop 284:8090, 1992. Statistical analysis: Sankey. Several limitations should be carefully considered when interpreting our results. 8600 Rockville Pike 2012;7(6):e39237. Steffee AD, Brantigan JW: The variable screw placement spinal fixation system: Report of a prospective study of 250 patients enrolled in Food and Drug Administration clinical trials. 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. 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. Zdeblick TA: A prospective randomized study of lumbar fusion: Preliminary results. Spine (Phila Pa 1976). 6 Of note, while only 38.2% (n = 26) of cases in our study mentioned the use of intraoperative radiographic confirmation, only one of these cases reported that the misplaced screw had been caught prior to leaving the operating room, which had resulted in an inadvertent dural tear and L5 nerve root injury. Neurologic injury. Moreover, local court rulings are not included in the Westlaw Edge database; however, this is unlikely to present meaningful bias given that malpractice claims are generally filed in state courts. This step in implant evolution was inevitable, because prior phases of implant development did not control each plane of motion segment stress. Copyright 1944-2023 American Association of Neurological Surgeons, Copy this link, or click below to email it to a friend. And while the jury debated for about two hours, at the end of its deliberation it sided with the defendants and entered a not guilty verdict. pedicle screws sagittal alignment spinal fusion surgical guides Spinal fusion is used to treat a range of conditions associated with spinal column such as intervertebral disc degeneration and scoliosis [ 1 ]. Spine Deform. 2. Cook County Surgeons Cut Common BIle Duct During Surgery, But Jury Finds for Defendants Irwin v. Alan Loren, M.D. This study revealed an overall accuracy rate of 95.2% of mainly percutaneously inserted pedicle screws according to the classification of Zdichavsky et al. to maintaining your privacy and will not share your personal information without A CT scan was taken to try and identify the underlying neurological problem that might be causing the new symptom. Autor de la entrada Por ; Fecha de la entrada austin brown musician; matrix toners for bleached hair . The patient had to undergo a subsequent surgery to remove the pedicles. Eur Spine J. There were 74 men and 38 women, with a mean age of 47 years (range, 1872 years). GraphPad Prism version 6.01 for Windows was used for all descriptive analyses (GraphPad Software). It should be used by experienced and qualified surgeons who are aware of the pitfalls associated with its use. 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. Elizabeth Hofheinz, M.P.H., M.Ed. Three slender patients complained of soft tissue irritation and a bothersome prominence because of the screws bulky profile. This study quantifies the rate of screw misplacement on a per-patient basis to highlight its effect on potential morbidity. 20 Tips to Avoid and Handle Problems in the Placement - ScienceDirect Screw misplacement. The accuracy rate of pedicle screw (PS) placement varies from 85% to 95% in the literature. Hecht N, Kamphuis M, Czabanka M, et al. Determining legal responsibility in otolaryngology: a review of 44 trials since 2008. Svider PF, Kovalerchik O, Mauro AC, et al. Robotic-assisted pedicle screw placement fails to reduce overall A.J. Conception and design: Sankey, KD Than. However, the highest offer had been a combined $300,000 from the two defendants. Pedicle screws are used by spine surgeons as part of a fusion in which two adjacent bones in the spine are combined together as one. Instead, the defense offered up an alternative explanation for Nyquists foot drop. 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. Reoperation for Misplaced Pedicle Screws: A Multicenter Retrospec Scarone P, Vincenzo G, Distefano D, et al. 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. As part of the surgery, Dr. Taras Masnyk inserted four metal screws into the plaintiffs spine. Accuracy of pedicle screw insertion by AIRO intraoperative CT in complex spinal deformity assessed by a new classification based on technical complexity of screw insertion. Comparison of pedicle screw placement accuracy between two types of Start; O firmie; Usugi; Serwis; Realizacje i porady; Kontakt 2011;213(5):657667. 13 Whitecloud et al 35 reported 15% neurologic complications, 5% being caused by incorrect screw placement. 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. Pedicle screw placement: Robotic assistance for greater precision The rate of medical complications was 8%. Inaccurate pedicle screw placement is relatively common even when placement is performed under fluoroscopic control. government site. Review of neurosurgery medical professional liability claims in the United States. Bydon M, Xu R, Amin AG, Macki M, Kaloostian P, Sciubba DM, Wolinsky JP, Bydon A, Gokaslan ZL, Witham TF. Likewise, cases are uploaded on a voluntary basis by state and federal judges and courts, which may lead to selection bias. There were no observed cases of screw misplacement outside the pedicle on routine AP and lateral radiographs. Pullout performance comparison of pedicle screws based on cement Study design: The link was not copied. J Spinal Disord Tech. However, only a few complications were related to a poor clinical outcome. In White AH, Rothman RH, Ray CD (eds). 70% of Pedicle Screws are misplaced - orthostreams.com 2017;27(4):470475. Also notable, only one claim reported the use of intraoperative CT and was ultimately ruled in favor of the defendant. 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. Malpractice claims in spine surgery in Germany: a 5-year analysis. Epstein NE. Although the rate of the reported medical complications was high (36.5%), these did not significantly affect the final clinical outcome of the current patients. Makhni MC, Park PJ, Jimenez J, et al. 2017;42(3):177185. Before Drafting the article: Sankey. Screws were divided into four categories: screws at risk (SAR), indeterminate misplacements (IMP), benign misplacements (BMP), accurately placed (AP). Risk factor analysis showed smaller Cobb angles increased likelihood of all screws being AP. Except for two patients with spinal metastatic disease, all other patients received an iliac crest autologous bone grafts. Lumbosacral pedicle screw placement using a fluoroscopic pedicle axis 2,24,28,36. J Bone Joint Surg 45A:11591170, 1963. The plaintiff underwent revision surgery in May 2013. Katonis, Pavlos MD*; Christoforakis, Joseph MD*; Aligizakis, Agisilaos C. MD*; Papadopoulos, Charalampos MD*; Sapkas, George MD, DSc**; Hadjipavlou, Alexander MD*. Except for the patient with an infected pseudarthrosis who had a flat back syndrome (sagittal imbalance) develop, coronal imbalance was observed in five patients (4.5%), and ranged from 7.5 to 12 (Fig 3). 15. Your message has been successfully sent to your colleague. Forty-seven intraoperative and medical complications were observed in 41 patients (36.6%). 2014 Aug 1;14(8):1702-8. doi: 10.1016/j.spinee.2014.03.044. 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. Through the use of expert witness testimony, Mr. da Costa was able to prove to the jury that by misplacing the pedicle screw during the surgery, and failing to timely diagnose and correct the malpositioned screw, Defendants deviated from accepted standards of care. 2012;37(1):6776. 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. leg pain. 30. Are We Underestimating the Significance of Pedicle Screw Misplacement 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. Intraoperative pedicle fractures requiring further points of fixation. Pedicle screw insertions are commonly used for posterior fixation to treat various spine disorders. Introduction. Careers. Defendant-awarded cases by US region (right). Disclaimer. Bethesda, MD 20894, Web Policies 2. J Neurosurg Spine. J Bone Joint Surg 54A:11951204, 1972. JAMA Intern Med. J Neurosurg. 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