pedicle screw misplacement malpractice
Pedicle screw fixation is an effective but demanding method to treat various spinal disorders and is associated with a significant complication rate. 13 Whitecloud et al 35 reported 15% neurologic complications, 5% being caused by incorrect screw placement. Spine J. Misplacement of Pedicle Screws Leads to Years of Pain and Opioid Addiction With pedicle shapes and sizes varying wildly in the scoliotic spine, misplacement of a screwas well as and under- or oversizingare real possibilities in spine surgery. Review of neurosurgery medical professional liability claims in the United States. Results. Cases involving wrong-level or -side surgery, implant malfunction, or other misplaced spinal instrumentation (e.g., interbody cases, rods, surgical instruments, etc.) Acta Neurochir (Wien). Rev Chir Orthop Reparatrice Appar Mot 62:151160, 1976. Lumbosacral pedicle screw placement using a fluoroscopic pedicle axis 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. 2. Fortunately, most of the complications were minor and transient. However, the medicolegal impact of misplaced screws on spine surgery has not been directly reported in the literature. This device was used with an early version of the Cotrel-Dubousset instrumentation to provide sacral fixation and it is rarely used since the more widespread use of newer spine fixation systems. PMC J Neurosurg Spine. All of these patients were asymptomatic and had satisfactory final clinical outcomes (Fig 2). 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. . J Neurosurg. National Library of Medicine government site. Scarone P, Vincenzo G, Distefano D, et al. Introduction. Clin Orthop 115:130139, 1976. Despite these failures, solid spinal arthrodesis was obtained in all patients. This step in implant evolution was inevitable, because prior phases of implant development did not control each plane of motion segment stress. All Rights Reserved. 2007;106(6):11081114. Nottmeier EW, Seemer W, Young PM. 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. Dr. Goodwin has received grants from the Burroughs Wellcome Fund, North Carolina Spine Society, and Robert Wood Johnson Harold Amos Medical Faculty Development Program and the NIH/NINDS K12 NRCDP Physician Scientist Award. Grubb SA, Lipscomb HJ: Results of lumbosacral fusion for degenerative disc disease with and without instrumentation: Two- to five-year follow-up. Safety and efficacy of pedicle screw placement using intraoperative computed tomography: consecutive series of 1148 pedicle screws. Drs. Incidence and costs of defensive medicine among orthopedic surgeons in the United States: a national survey study. 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. Author links open overlay panel Mohamad Bydon a b 1, Dimitrios Mathios a b 1, Mohamed Macki a b, Rafael De la Garza-Ramos a b, Nafi Aygun c, Daniel M. Sciubba a, Timothy F. Witham a, Ziya L. Gokaslan a b, Ali Bydon a b, Jean-Paul Wolinksy a. Preparation. The site is secure. McLaughlin WM, Donnelley CA, Yu K, Gillinov SM, Tuason DA. Arthrodesis was questionable in eight asymptomatic patients (7.1%). As part of the surgery, Dr. Taras Masnyk inserted four metal screws into the plaintiffs spine. Among the plaintiff-awarded cases, 13 (61.9%) were decided by jury trial, 7 (33.3%) by settlement, and 1 (4.8%) by arbitration. Submitting a contact form, sending a text message, making a phone call, or leaving a voicemail does not create an attorney-client relationship. 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. J Spinal Disord Tech. Lumbar Spine Surgery. Achieving proper lumbar lordosis, evaluating any preexisting scoliosis, and intraoperative assessment with AP radiographs could prevent balance problems. Cook County Surgeons Cut Common BIle Duct During Surgery, But Jury Finds for Defendants Irwin v. Alan Loren, M.D. 17. Dr. Abd-El-Barr is a consultant for Spineology. Bookshelf Jury Verdict for Doctor for Screw Allegedly Misplaced During Lumbar Spine (Phila Pa 1976). Drafting the article: Sankey. Spine 18:18621866, 1993. Malpractice issues in neurological surgery. Results: 3). To prevent the development of pseudarthrosis, we think it is important for surgeons to apply the following five technical principles: the proper-sized pedicle screw has to be inserted on the first attempt; repeated manipulation in setting instruments must be avoided; anterior penetration of the screw into the sacrum and insertion of two screws in each side are advocated for fixing the lumbosacral junction; industrious and detailed decortication of the posterior elements must be developed fully; and the use of autologous bone graft is recommended. Jena AB, Seabury S, Lakdawalla D, Chandra A. 1 Although this technique has advantages over open instrumentation, it also presents new challenges and specific complications. 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). Two patients had early postoperative postural headache that disappeared after removal of the misplaced screw. 2014;20(2):196203. Also notable, only one claim reported the use of intraoperative CT and was ultimately ruled in favor of the defendant. Accuracy of fluoroscopically-assisted pedicle screw placement: analysis of 1,218 screws in 198 patients. The pedicle screws judged as misplacement. a Medial minor perforation Error in trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. PDF Intraoperative biomechanics of lumbar pedicle screw loosening following Axial lumbar CT scans demonstrating both laterally (right) and medially (left) misplaced pedicle screws, resulting in pedicle and transverse process fractures (A) and canal compromise (A and B). Methods. 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). 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. Three slender patients complained of soft tissue irritation and a bothersome prominence because of the screws bulky profile. 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. However, 5-10% of those misplaced screws are cause for concern." "To rectify this, we must have access to imaging devices during the procedure. The https:// ensures that you are connecting to the Whitecloud III TS, Butler JC, Cohen JL, Candelora PD: Complications with the variable spinal plating system. 2017;31(3):287288. 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. 24. GraphPad Prism version 6.01 for Windows was used for all descriptive analyses (GraphPad Software). Waddell G, Kummell EG, Lotto WN, et al: Failed lumbar disc surgery and repeat surgery following industrial injuries. Under this theory of liability, the plaintiff needed to not only establish that she had experienced foot drop, a fact that no one was disputing, but that it was caused by the defendants negligence. 8,24,25,32. 28. Copyright 2023 Becker's Healthcare. 10. Data is temporarily unavailable. Brodsky AE: Post-laminectomy and post-fusion stenosis of the lumbar spine. The third surgical procedure removed the pedicle screws but left the patient in an unfused state with an unstable spine. Furthermore, 25 patients (22.3%) reported persistent pain in the iliac crest (donor graft site) for several months, for which they were treated with repeated lidocaine injections and analgesics. Complete degeneration of the upper disc developed in two patients who had spinal stenosis and degenerative scoliosis. Ultimately, additional prospective, multiinstitutional large-volume studies are needed to validate these findings, and future studies should evaluate the long-term impact on the routine use of intraoperative imaging confirmation and/or computer- or robot-assisted navigation on the frequency and success of malpractice claims related to misplaced pedicle and lateral mass screws. Intraoperative pedicle fractures requiring further points of fixation. However, published reports are increasingly demonstrative of the positive effect of pedicle fixation on arthrodesis and successful outcome in the treatment of patients with these disorders. Pedicle screw placement accuracy impact and comparison between grading The jury found the defendants liable and allocated 75 percent of the fault to Dr. Friedlander and 25 percent to Dr. Bradley. 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. 35. (%), Pseudarthrosis requiring revision surgery. Several studies have shown that spine surgery is at the highest risk for litigation among the surgical subspecialties.12,29 The majority of claims are related to technical and procedural errors,29 including misplaced pedicle and/or lateral mass screws. Can Postoperative Radiographs Accurately Identify Screw Misplacements? St Louis, CV Mosby 322327, 1987. 2018;18(2):209215. Aigner R, Bichlmaier C, Oberkircher L, Knauf T, Knig A, Lechler P, Ruchholtz S, Frink M. BMC Musculoskelet Disord. At the trials close, the plaintiffs attorney had asked the jury to return a $5.3 million verdict and had made a prior demand to settle the medical malpractice lawsuit for $1 million. In White AH, Rothman RH, Ray CD (eds). 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. 4. Pedicle screw placement is a common procedure. It should be used by experienced and qualified surgeons who are aware of the pitfalls associated with its use. 27. 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. 2018;28(2):186193. Defensive medicine in U.S. spine neurosurgery. 3,4,9,29,34 In addition, developments in surgical technique and implant design have decreased operative risk and implant-related complications. In situ spine arthrodesis permits load sharing by the vertebral bodies, preventing fatigue failure of the implant. A.J. Per-patient analysis showed 23 (18.11%) of patients had all screws AP. Percentage of cases per US region (center). The medical malpractice suit Ayala v. Friedlander, M.D., claimed that a March 2011 lumbar fusion surgery performed by neurosurgeon Marvin Friedlander, MD, and orthopedic spine surgeon Douglas Bradley, MD, strayed from the accepted standards of care because a pedicle screw was placed in the wrong location. 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. 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. 70% of Pedicle Screws are misplaced - orthostreams.com Pedicle screw insertions are commonly used for posterior fixation to treat various spine disorders. Spine 18:23252326, 1993. doi: 10.1097/BPO.0000000000001828. Subjects were 10,754 patients (73,777 pedicle screws) who underwent PSF at 11 hospitals over 15 years. 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. Malpractice litigation following spine surgery. In the current study, no incidence of bent and broken screws or tulip screw plug dislodgement necessitated additional treatment, and all the patients achieved solid fusion despite the failure of instrumentation. Comparison of pedicle screw placement accuracy between two types of This retrospective study analyzes the complications and the problems developed during and after pedicle screw fixation in patients with spinal disorders and trauma. Please enable scripts and reload this page. As part of the surgery, Dr. Taras Masnyk inserted four metal screws into the plaintiff's spine. may email you for journal alerts and information, but is committed 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. All these problems were observed only just above the upper instrumentation level and all were observed in patients older than 55 years. Using Low-Dose, Biplanar Imaging to Reduce Screw Misplacement. Unfortunately, the plaintiffs attorney was unable to offer an alternative theory of surgical negligence that would refute the defendants explanation. J Neurosurg Spine. Forty-seven intraoperative and medical complications were observed in 41 patients (36.6%). 2014;20(6):636643. However, following the spinal fusion, Nyquist began to experience foot drop in her right foot. Spine 16:576579, 1991. 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. This study quantifies the rate of screw misplacement on a per-patient basis to highlight its effect on potential morbidity. Schlegel JD, Smith JA, Schleusener RN: Lumbar motion segment pathology adjacent to thoracolumbar, lumbar, and lumbosacral fusions. First, this is a retrospective analysis of cases obtained from the web-based Westlaw Edge legal research database. Wolters Kluwer Health Spine 16(8 Suppl):S422427, 1991. Thoracic pedicle screw placement: Free-hand technique - Bioline your express consent. Din RS, Yan SC, Cote DJ, et al. 2013;34(6):699705. Unilateral nonunion was seen in three patients (2.7%), associated with implant failure in one of the patients. Katonis PG, Kontakis GM, Loupasis GA, et al: Treatment of unstable thoracolumbar and lumbar spine injuries using Cotrel-Dubousset instrumentation.
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pedicle screw misplacement malpractice