Lali Sekhon, Jocelyn Idema & more: 4 spine and neurosurgeons making headlines, Spinal cord stimulation trumps medication for pain reduction 7 takeaways, Dr. Khalid Kurtom on major trends in spinal cord injury surgery. 2022 Sep 15;14(9):6323-6331. eCollection 2022. Elsamadicy AA, Sergesketter AR, Frakes MD, Lad SP. 2020;45(2):E111E119. 31. Illinois Jury Finds in Favor of Doctor in Gallbladder Surgery that Led to Fatal Bowel Perforation Nickl v. Barry S. Rosen, M.D. These risks can be minimized by the judicious use of instrumentation by experienced surgeons for specific indications as supported by the literature. The rate of reoperation for screw misplacement per screw was 0.17%. The rate of medical complications was 8%. 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. The medicolegal landscape of spine surgery: how do surgeons fare? We attribute the 24.1% disc space narrowing in the instrumented segments mainly to the severe injury of the disc and communication of the end plate in burst fractures, which could accelerate the disc degeneration and narrowing. National Library of Medicine Spine Deform. Plaintiff award amounts were adjusted for inflation as of April 2020 using an online inflation calculator provided by the US Bureau of Labor Statistics (https://www.bls.gov/data/inflation_calculator.htm). The third patient, who had central spinal stenosis, was treated by decompression alone. 2018;28(2):186193. The authors of the current study aimed to describe this impact in the United States, as well as to suggest a potential method for mitigating the problem. 17. J Neurosurg Spine. This demonstrates technical ability but does not represent the impact of screw misplacement on individual patients. Careers. Hardware-related failures were observed in 12 patients (10.7%). Pedicle instrumentation in the thoracolumbar and lumbar spine is a technically challenging procedure. 12. (A) Anteroposterior and (B) lateral radiographs taken 2 years after surgery show unilateral pseudarthrosis in a 55-year-old man with spinal stenosis. 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. However, this difference was no longer significant when adjusted for inflation ($1,016,000 $90,875 vs $1,630,000 $422,405, p = 0.09). Epstein NE. Eur Spine J. 2014 Sep;21(3):320-8. doi: 10.3171/2014.5.SPINE13567. Error in trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. With increasing pedicle screw usage, the number of patients with misplaced screws will likely increase proportionally. Luque ER: Segmental spinal instrumentation of lumbar spine. Conclusion: Kreisman Law Offices has been handling Illinois surgical error lawsuits for individuals and families for more than 35 years in and around Chicago, Cook County and surrounding areas, including Batavia, Bellwood, Deerfield, Evanston, Franklin Park, and Lansing. Unable to load your collection due to an error, Unable to load your delegates due to an error. 2012;7(6):e39237. Back pain/spinal stenosis and neurogenic claudication/radiculopathy were the most frequently reported indications for the index surgery, accounting for 13 (19.1%) and 11 (16.2%) cases, respectively. Spine surgery has been disproportionately impacted by medical liability and malpractice litigation, with the majority of claims and payouts related to procedural error. Legal liability in iatrogenic orbital injury. Re: malpositioned pedicle screw resulting in additional surgery and disability. laterally placed screws and the azygous vein on the right (T5-T11). 13 Whitecloud et al 35 reported 15% neurologic complications, 5% being caused by incorrect screw placement. Dr. K. D. Than is a consultant for Bioventus and receives honoraria from DJO and LifeNet Health. Characteristics of medicolegal cases related to misplaced screws in spine surgery. 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. Pedicle screw insertions are commonly used for posterior fixation to treat various spine disorders. There were nine instrumentation failures at the thoracolumbar area (seven patients), lumbar area (one patient), and lumbosacral area (one patient). The pedicle screw system is widely used in spine surgery, and it provides rigid fixation and leads to successful subsequent deformity correction and bony fusion. George Sapkas, MD, DSc; and Panayiotis J. Papagelopoulis, MD, DScGuest Editors. Although the rate of the reported complications was high, the final outcome of the patients was not affected significantly. [] The accuracy for free-hand screw placement technique varies from 69% to 94%. Would you like email updates of new search results? A total of 47 (69.1%) cases resulted in a decision for the defendant and 21 (30.9%) for the plaintiff. Spine 17:834837, 1992. 37. Methods. Spine 13:952953, 1988. Several limitations should be carefully considered when interpreting our results. Pedicle screw insertion in the thoracolumbar spine. The contact form sends information by non-encrypted email, which is not secure. Feb. 16, 2021 Accurate placement of pedicle screws is key to avoiding the potential complications of spinal fusion surgery and improving overall spinal fixation. Am J Otolaryngol. 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). Bethesda, MD 20894, Web Policies Pediatric pedicle screw placement using intraoperative computed tomography and 3-dimensional image-guided navigation. 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). The amount awarded was not significantly different across US regions (p = 0.9; Fig. Over 40% of patients had screws with either some/major concern. Cookie Policy. Drafting the article: Sankey. Problems in the instrumented segments were considered those occurring from narrowing of the disc space greater than 3 mm, pseudarthrosis, and loss of reduction. Intraoperative pedicle fractures requiring further points of fixation. J Neurosurg 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. J Bone Joint Surg 54A:11951204, 1972. Health Aff (Millwood). Of note, the award amount for one settlement case was undisclosed. Daniels AH, Ruttiman R, Eltorai AEM, et al. Misplaced pedicle and lateral mass screws result in a considerable risk of malpractice litigation against spine surgeons. Surg Neurol. Laryngoscope. The total number of reoperations for MPS and patient clinical data were obtained from medical records at each hospital. 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. Forty-seven intraoperative and medical complications were observed in 41 patients (36.6%). 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 study revealed an overall accuracy rate of 95.2% of mainly percutaneously inserted pedicle screws according to the classification of Zdichavsky et al. 2. However, the misplacement of pedicle screws can lead to disastrous complications. 2021 Nov;9(6):1541-1548. doi: 10.1007/s43390-021-00377-5. 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. The median time to case closure was 56.3 (35.267.2) months when ruled in favor of the plaintiff (i.e., patient) compared to 61.5 (51.477.2) months for defendant (surgeon) verdicts (p = 0.117). The plaintiff underwent revision surgery in May 2013. West et al 33 also reported a 29% complication rate for the first 50 patients and a 26% complication rate for the last 74 patients. Spine (Phila Pa 1976). Hadjipavlou A, Enker P, Dupuis P, Katzman S, Silver J: The causes of failure of lumbar transpedicular spinal instrumentation and fusion: A prospective study. J Neurosurg Spine. 27,30 Infected pseudarthrosis developed in one patient (0.9%) with an L4S1 arthrodesis, and the instrumentation was removed 18 months later resulting in a flat back syndrome. Pedicle screw fixation is an effective but demanding method to treat various spinal disorders and is associated with a significant complication rate. 2012;21(suppl 2):S196S199. West III JL, Bradford DS, Ogilvie JW: Complications of the variable screw pedicle screw fixation. Spine 15:908912, 1990. Among the plaintiff-awarded cases, 13 (61.9%) were decided by jury trial, 7 (33.3%) by settlement, and 1 (4.8%) by arbitration. Acta Neurochir (Wien). The screws were needed to stabilize the spine and fix the fused vertebrae in place. Eur Spine J. We avoid using sharp automated drilling, and probe fully the pedicle cavity to prevent nerve root impairment. 2022 Jun;8(2):234-241. doi: 10.21037/jss-22-28. 6 Per-patient analysis reveals more concerning numbers toward screw misplacement. Your current browser may not support copying via this button. 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%). It should be used by experienced and qualified surgeons who are aware of the pitfalls associated with its use. Similarly, the highest inflation-adjusted amount awarded ($2,302,472) for pseudarthrosis was attributed to a medially breached pedicle screw during an L5S1 fusion that was determined to have caused the failed union and subsequent need for revision surgery. McAfee PC, Weiland DJ, Carlow JJ: Survivorship analysis of pedicle spinal instrumentation. Please enable it to take advantage of the complete set of features! J Neurosurg. Introduction. Descriptive analysis of state and federal spine surgery malpractice litigation in the United States. 2005;293(21):26092617. In addition, the median time to judgment is substantial, particularly for defendant verdicts, spanning over 4.5 years from the time of surgery. The purpose of current study was to analyze the complications and problems during and after pedicle screw fixation for various spinal disorders and trauma. The accuracy of pedicle screw placement using intraoperative image guidance systems. While reported to be one of the best legal research resources available and utilized in several previous studies,7,14,16,23,24 available court documents and clinical/operative details are highly variable and greatly limited among case files. 1. Summary of background data: 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. Problems at the junctions of the instrumented spine were seen in five patients (4.5%). Dr. Abd-El-Barr is a consultant for Spineology. Orthopedics. Rothberg MB, Class J, Bishop TF, et al. 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 Johnston II CE, Ashman RB, Baird AM, Allard RN: Effect of spinal construct stiffness on early fusion mass incorporation: Experimental study. Routine CT scans were taken in all patients. Spine 15:1114, 1990. JAMA Intern Med. Friedlander and Bradley will pay half of the $2.25 million. Judgment information associated with a defendant (surgeon) versus plaintiff (patient) ruling, trial versus settlement versus arbitration decision, award amount, and time to decision or case closure from index surgery was also recorded.