pedicle screw misplacement malpractice pedicle screw misplacement malpractice

Eur Spine J. Whitecloud III TS, Butler JC, Cohen JL, Candelora PD: Complications with the variable spinal plating system. Saillant G: Etude anatomique des pedicules vertebraux: Application chirurgicale. Dr. Friedlander did not order a CT or MRI until January 2013, when the pedicle screw was found to be in the wrong location and a failed fusion was diagnosed, according to the suit. Procedural errors led to combined payouts totaling $124,943,933 in neurosurgery claims between 2003 and 2012 in a study looking at data from the Physician Insurers Association of America Data Sharing Project.10 However, our study is the first to report the direct medicolegal impact of screw misplacement on US spine surgery, with 30.9% of judgments/settlements in favor of the plaintiff, resulting in average payouts of $1,204,422 $753,832 per claim. Ultimately, no significant differences in case demographics were found between plaintiff and defendant judgments (Table 1). Plaintiff's expert was prepared to testify at trial that these complaints are characteristic of a malpositioned screw impinging upon a neural structure. The total number of reoperations for MPS and patient clinical data were obtained from medical records at each hospital. The average followup was 35 months (range, 1851 months). Luque ER: Segmental spinal instrumentation of lumbar spine. Edmunds I, Cummine J, Fearnside M: Prevention of dislodgement of Cotrel-Dubousset rods from tulip screws. Ann R Coll Surg Engl. 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. Analysis and interpretation of data: Sankey, TT Than. 24. Additional survey data have shown that 50% of physicians exhibit at least a temporary loss of self-esteem after a malpractice claim, and at least 25% experience depression.22 As stated above, the average neurosurgeon spends 27.2% of his or her entire career in an open malpractice claim,10 and each case can take an average of 5.1, 5.0, and 3.4 years for defendant verdicts, plaintiff rulings, and settlements, respectively.7,15 Likewise, neurosurgeons have a higher risk than practitioners in other specialties of being named in multiple malpractice suits given the particularly high-risk nature of the specialty.10 Even when found in favor of the defendant (surgeon), each case ultimately takes a substantial emotional and financial toll on the physician(s) involved. Mason A, Paulsen R, Babuska JM, et al. Am J Otolaryngol. The cost of defensive medicine on 3 hospital medicine services. Patient safety: disclosure of medical errors and risk mitigation. Phone/Fax: 30-2810-318361; E-mail: [emailprotected]. were excluded from analysis. A total of 247 screws (9.07%) were BMP, 52 (1.91%) were IMP, and 29 (1.06%) were considered SAR. J Neurosurg Spine. Plaintiff-awarded cases by US region (left). MeSH 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. Cookie Policy. Forty-seven general complications were seen in 41 patients (36.5%). The largest inflation-adjusted payout awarded to the plaintiff ($3,372,185) for nerve root injury occurred in a 36-year-old male who had undergone an L4S1 posterior spinal fusion, which resulted in permanent and direct injury to right L5 and S1 nerve roots, with foot drop and radiculopathy. Copyright © 2023 Becker's Healthcare. Clin Orthop 203:126134, 1986. to maintaining your privacy and will not share your personal information without doi: 10.1097/BRS.0b013e31822a2e0a. 8. A retrospective review of charts, x-rays (XRs) and computed tomography (CT) scans was performed. This site needs JavaScript to work properly. Seven hundred sixty-three screws were inserted in 138 patients. Spine (Phila Pa 1976). Spine arthrodesis was evaluated with plain AP and lateral radiographs taken 1 year after surgery. 13 Whitecloud et al 35 reported 15% neurologic complications, 5% being caused by incorrect screw placement. A total of 69 patients (mean age, 67.416 . Balch CM, Oreskovich MR, Dyrbye LN, et al. Epstein NE. There were no observed cases of screw misplacement outside the pedicle on routine AP and lateral radiographs. Spine 18:23252326, 1993. 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. Hsu K, Zucherman JF, White AH: Internal Fixation With Pedicle Screws. Routine CT scans were taken in all patients. Aigner R, Bichlmaier C, Oberkircher L, Knauf T, Knig A, Lechler P, Ruchholtz S, Frink M. BMC Musculoskelet Disord. 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. Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. Epub 2022 Oct 29. 2011;306(10):1088. Epstein NE. Screws were divided into four categories: screws at risk (SAR), indeterminate misplacements (IMP), benign misplacements (BMP), accurately placed (AP). Whitecloud et al 35 reported an overall 45% rate of minor and major complications, with the rate of complications increasing to 63% in patients who had previous lumbar surgery. 2017 Mar;5(2):109-116. doi: 10.1016/j.jspd.2016.10.007. Please try after some time. 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. 32. Schlegel JD, Smith JA, Schleusener RN: Lumbar motion segment pathology adjacent to thoracolumbar, lumbar, and lumbosacral fusions. However, the medicolegal impact of misplaced screws on spine surgery has not been directly reported in the literature. 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. A retrospective review of closed medicolegal cases with verdicts or settlements between 1995 and 2019 was performed using the Westlaw Edge legal research database (Thomson Reuters).7,14,16,23,24 A search of closed federal and state malpractice claims within the Verdicts and Settlements section consisted of the following: spine and surgery and pedicle and screw and fusion and (misplaced or misguided or mispositioned) and surgeon. Inclusion criteria consisted of malpractice claims against surgeons for complications related to misplaced pedicle and/or lateral mass screws. In unstable injuries, the segments above and below the level of injury may have a different orientation of the pedicle trajectory due to . Am J Transl Res. JAMA Intern Med. For more information, please refer to our Privacy Policy. Careers. Ultimately, no significant differences were seen in inflation-adjusted award information between plaintiff and defendant (Table 3). The screws were needed to stabilize the spine and fix the fused vertebrae in place. Zucherman J, Hsu K, Picetti III G, et al: Clinical efficacy of spinal instrumentation in lumbar degenerative disc disease. Spinal fusion in the United States: analysis of trends from 1998 to 2008. A total of 47 (69.1%) cases resulted in a decision for the defendant and 21 (30.9%) for the plaintiff. Of note, the award amount for one settlement case was undisclosed. The third patient, who had central spinal stenosis, was treated by decompression alone. Pediatric pedicle screw placement using intraoperative computed tomography and 3-dimensional image-guided navigation. Error in trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. 2020;162(6):13791387. Jury awards $4.5M over misplaced pedicle screw during spine surgery: 5 things to know Spine Monday, May 7th, 2018 Post Listen Text Size On April 6, a Union County, N.J., jury awarded a plaintiff $4.5 million over a botched spine surgery. 16. As part of the surgery, Dr. Taras Masnyk inserted four metal screws into the plaintiffs spine. NCI CPTC Antibody Characterization Program. 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. Hadjipavlou A, Enker P, Dupuis P, Katzman S, Silver J: The causes of failure of lumbar transpedicular spinal instrumentation and fusion: A prospective study. Nayar G, Blizzard DJ, Wang TY, et al. J Spine Surg. Daniels AH, Ruttiman R, Eltorai AEM, et al. 2012 Feb 1;37(3):E188-94. The rod is held in place by "pedicle screws," which the surgeon must insert into the pedicles. Thus, in the current study we aimed to describe this impact in the US, as well as to suggest a potential method for mitigating the problem. Defendant-awarded cases by US region (right). 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). Accuracy and workflow of navigated spinal instrumentation with the mobile AIRO CT scanner. Objective: 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). Results: Spine J. 2,24,28,36. Except for two patients with spinal metastatic disease, all other patients received an iliac crest autologous bone grafts. Potential complications may include increased pain, infection, or mechanical . Nahed BV, Babu MA, Smith TR, Heary RF. Scarone P, Vincenzo G, Distefano D, et al. Neurologic injury. Louw JA, Dommissee GF, Roos MF: Spinal stenosis following anterior spinal fusion. Complete degeneration of the upper disc developed in two patients who had spinal stenosis and degenerative scoliosis. Junctional problems were recorded as pathologic changes of the adjacent motion segments, just above and below the instrumented and fused segments. INCLUDE WHEN CITING DOI: 10.3171/2020.8.FOCUS20600. 28. 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. In six patients (5.3%) with degenerative spine disease, the disc material had been removed. Smith TR, Hulou MM, Yan SC, et al. pedicle screw: A rigid surgical implant used to stabilize adjacent spinal segments in spinal fusion surgery. Copyright 1944-2023 American Association of Neurological Surgeons, Copy this link, or click below to email it to a friend. Privacy Policy. Don't jump in get legal help. Legal liability in iatrogenic orbital injury. Figure 1: Lower thoracic pedicles provide the firm purchase of the pedicle screw from a lateral starting point and 10-15 degrees convergent angle Surgical technique "Free Hand" pedicle screw placement [50] Our "Free Hand" technique is equivalent for lumbar and The development of the transpedicle screw has provided control of the vertebral motion segment in each plane, resisting any type of load. Spine 13:952953, 1988. Error in trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults, Spinal fusion in the United States: analysis of trends from 1998 to 2008, Safety and efficacy of pedicle screw placement using intraoperative computed tomography: consecutive series of 1148 pedicle screws, The accuracy of pedicle screw placement using intraoperative image guidance systems, 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, 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, Use of the Airo mobile intraoperative CT system versus the O-arm for transpedicular screw fixation in the thoracic and lumbar spine: a retrospective cohort study of 263 patients, Accuracy and workflow of navigated spinal instrumentation with the mobile AIRO, 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, Safety and accuracy of robot-assisted versus fluoroscopy-guided pedicle screw insertion for degenerative diseases of the lumbar spine: a matched cohort comparison, Verdict/Settlement Search and Inclusion/Exclusion Criteria, Plaintiff Claim and Index Surgery Information, Impact of Medical Malpractice on Neurosurgeon and Orthopedic Surgeon Careers, Financial Burden of Medical Malpractice Claims Related to Misplaced Pedicle and/or Lateral Mass Screws, Frequency of Misplaced Pedicle and Lateral Mass Screws in Spine Surgery, Strategies to Improve the Accuracy of Screw Placement in Spine Surgery, Top 25 Cited Gamma Knife Surgery Articles - Trigeminal Neuralgia, Top 25 Cited Gamma Knife Surgery Articles - Volume 111, https://doi.org/10.3171/2020.8.FOCUS20600, https://www.bls.gov/data/inflation_calculator.htm, Volume 49 (2020): Issue 5 (Nov 2020): Medicolegal issues in neurosurgery, Single vs multiple misplaced screw(s), no. A rod is used to hold the vertebra together to allow fusion to occur. Pedicle instrumentation in the thoracolumbar and lumbar spine is a technically challenging procedure. 6. There were 74 men and 38 women, with a mean age of 47 years (range, 1872 years). The jury found the defendants liable and allocated 75 percent of the fault to Dr. Friedlander and 25 percent to Dr. Bradley. Presse Med 78:14471448, 1970. 27. 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. The contact form sends information by non-encrypted email, which is not secure. J Neurosurg Spine. However, the impact of robotic-assisted spinal fusion on patient outcomes is less clear. The patient had subsequent coronal imbalance and degeneration of the upper disc. With increasing pedicle screw usage, the number of patients with misplaced screws will likely increase proportionally. The majority of plaintiffs were male (n = 44, 64.7%), and the median age among all cases was 46 years (range 3757 years). In patients with degenerative conditions, all of the affected segments were included in the instrumentation and each vertebra was fixed with two pedicle screws. 15. demonstrated that the number of hospital discharges for spinal fusion increased 2.4 times (137%) from 174,223 to 413,171 (p < 0.001) between 1998 and 2008.32 The true frequency of malpositioned pedicle and lateral mass screws is likely underestimated in spine surgery given the fact that the majority of misplaced screws, as well as the potential complications related to them, are not reported in practice and may be clinically silent. 2018;29(4):397406. Intraoperative pedicle fractures requiring further points of fixation. 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