Seven hundred sixty-three screws were inserted in 138 patients. Complete degeneration of the upper disc developed in two patients who had spinal stenosis and degenerative scoliosis. Previous biomechanical and clinical studies defining junctional segment problems are lacking and consist mainly of case reports. Pullout performance comparison of pedicle screws based on cement application and design parameters Tolga Tolunay, Cemile Bagl, Teyfik Demir, Mesut E Yaman, and Arslan K Arslan Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 2015 229: 11 , 786-793 Download Citation Using Low-Dose, Biplanar Imaging to Reduce 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%). Potential complications may include increased pain, infection, or mechanical . The jury found the defendants liable and allocated 75 percent of the fault to Dr. Friedlander and 25 percent to Dr. Bradley. Plaintiff's expert was prepared to testify at trial that these complaints are characteristic of a malpositioned screw impinging upon a neural structure. Makhni MC, Park PJ, Jimenez J, et al. Three-dimensional printing versus freehand surgical techniques in the surgical management of adolescent idiopathic spinal deformity. Harrington PR, Tullos HS: Reduction of severe spondylolisthesis in children. Elizabeth Hofheinz, M.P.H., M.Ed. HHS Vulnerability Disclosure, Help Five patients had uneventful early postoperative course. Wolters Kluwer Health Once the spine is exposed, the appropriate levels of fixation are confirmed with the image intensifier. 2011;306(10):1088. Eur Spine J. Nyquist had requested the defendants offer, which in retrospect was perhaps a poor decision in light of the Kane County jurys verdict. Svider PF, Kovalerchik O, Mauro AC, et al. Pediatric pedicle screw placement using intraoperative computed tomography and 3-dimensional image-guided navigation. Moffatt-Bruce SD, Ferdinand FD, Fann JI. Neurosurgeons and orthopedic surgeons were named as the defendant in an equal number of cases, and the decision for the plaintiff versus the defendant was also similar between specialties. 2016;124(5):15241530. Fager CA. 6 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. Pedicle screw replacement in spinal surgery - The MDU Quinnell RC, Stockdale HR: Some experimental observations of the influence of a single lumbar floating fusion on the remaining lumbar spine. Plaintiff-awarded cases by US region (left). St Louis, CV Mosby 322327, 1987. Pedicle screw insertion - AO Foundation The majority of plaintiffs were male (n = 44, 64.7%), and the median age among all cases was 46 years (range 3757 years). Dr. Shaffrey holds patents with, receives royalties from, and is a consultant for Medtronic, NuVasive, and Zimmer Biomet; is a stockholder in NuVasive; is a consultant for K2M, Stryker, SI Bone, and In Vivo; and has received grants from the ISSG, DePuy Synthes, and AO Spine. The pedicle screws judged as misplacement. a Medial minor perforation Importantly, these advanced technologies are not always readily available or the standard of care and cannot supplant a thorough understanding of operative anatomy, a high-quality surgical technique, and general complication-avoidance measures. 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. Spine 13:696706, 1988. Problems at the junctions of the instrumented spine were seen in five patients (4.5%). 1. All the incidental dural tears were repaired immediately and produced no clinical sequelae. 2014;96(4):266270. The defendants explanation provided an explanation for why Nyquists foot drop did not resolve after the misplaced screw was removed and shed doubt on the plaintiffs theory of liability. Nayar G, Blizzard DJ, Wang TY, et al. 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. Pullout strength of misplaced pedicle screws in the thoracic and lumbar 2022 Sep 15;14(9):6323-6331. eCollection 2022. The accuracy of pedicle screw placement using intraoperative image guidance systems. PMC 2014;174(11):18671868. Stauffer RN, Coventry MB: Posterolateral lumbar-spine fusion: Analysis of the Mayo clinic series. 2012 Feb 1;37(3):E188-94. 2016;25(3):716723. Per-patient analysis reveals more concerning numbers toward screw misplacement. Defensive medicine in neurosurgery: the Canadian experience. 2018;18(2):209215. 2. Malpractice litigation following spine surgery. Image intensification and the technique recommended by Weinstein et al 32 was used for screw placement in the lumbar vertebrae, whereas Chopin blocks (Medtronic Sofamor Danek) with two screws diverging bilaterally were used for sacral fixation. 2009;10(1):3339. J Neurosurg. In addition, seven (6.3%) dural tears occurred during the decompression and none occurred during instrumentation. Feb. 16, 2021 Accurate placement of pedicle screws is key to avoiding the potential complications of spinal fusion surgery and improving overall spinal fixation. 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. Spine 18:18621866, 1993. Edmunds I, Cummine J, Fearnside M: Prevention of dislodgement of Cotrel-Dubousset rods from tulip screws. 8,24,25,32. Spine 15:1114, 1990. concluded that the robot-assisted technique was significantly more accurate than the traditional freehand technique.39 Despite the learning curve and initial cost of obtaining technologies such as 3D fluoroscopic devices, intraoperative CT, or robotic navigational systems, the routine use of these technologies for intraoperative imaging confirmation and potential revision of misplaced screws may help spine surgeons avoid inadvertent iatrogenic morbidity for their patients and potential litigation. Pedicle screw construct have become one of the most practiced procedure in spinal surgery. Two patients had early postoperative postural headache that disappeared after removal of the misplaced screw. Malpractice litigation and the spine: the NHS perspective on 235 successful claims in England. Seabury SA, Chandra A, Lakdawalla DN, Jena AB. (%), Pseudarthrosis requiring revision surgery. 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%). Brodsky AE: Post-laminectomy and post-fusion stenosis of the lumbar spine. Each case was then carefully screened for relevance and sufficient data. 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. It is easier to confuse a jury than convince a judge: the crisis in medical malpractice. In our opinion, these problems may be prevented by applying the following principles: limitation of spine arthrodesis to the pathologic levels, inclusion of already extensive changes at the level above or below the planned arthrodesis into the arthrodesis, restoration of postoperative sagittal and coronal alignment, and avoidance of impingement syndrome from the adjacent nonfused facets. Legal liability in iatrogenic orbital injury. Sub-analysis of adolescent idiopathic scoliotic patients showed no curve or patient characteristic that correlated with IMP or SAR. doi: 10.1097/BPO.0000000000001828. Weinstein JN, Spratt KF, Spengler D, Brick C, Reid S: Spinal pedicle fixation: Reliability and validity of roentgenogram-based assessment and surgical factors on successful screw placement. 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. 2017;27(4):470475. Nottmeier EW, Seemer W, Young PM. 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. Malpractice liability and defensive medicine: a national survey of neurosurgeons. The plaintiff received $2.4 million for pain and suffering and loss of enjoyment of life, $2 million for lost income and approximately $123,000 for medical expenses. Lumbar Spine Surgery. J Pediatr Orthop. These numbers are in line with the current literature. Clin Orthop 203:4553, 1986. 2018;28(2):186193. In six of these patients with injuries at the thoracolumbar area (four patients with bent screws and two patients with broken screws), the loss of correction ranged from 3 to 4.5 without change of anatomic reduction (Fig 1). Aigner R, Bichlmaier C, Oberkircher L, Knauf T, Knig A, Lechler P, Ruchholtz S, Frink M. BMC Musculoskelet Disord. The medicolegal impact of misplaced pedicle and lateral mass screws on Guillain A, Moncany AH, Hamel O, et al. J Spine Surg. Spine (Phila Pa 1976). One common area for the potential avoidance of malpractice claims and subsequent payouts involves misplaced pedicle and/or lateral mass instrumentation. In White AH, Rothman RH, Ray CD (eds). 2005;293(21):26092617. 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. Pedicle screw insertions are commonly used for posterior fixation to treat various spine disorders. Unable to load your collection due to an error, Unable to load your delegates due to an error. The rod is held in place by "pedicle screws," which the surgeon must insert into the pedicles. J Bone Joint Surg 62A:13021307, 1980. The development of the transpedicle screw has provided control of the vertebral motion segment in each plane, resisting any type of load. PDF Intraoperative biomechanics of lumbar pedicle screw loosening following were excluded from analysis. Smith TR, Hulou MM, Yan SC, et al. 28. Friedlander and Bradley will pay half of the $2.25 million. pedicle screw: A rigid surgical implant used to stabilize adjacent spinal segments in spinal fusion surgery. Ann R Coll Surg Engl. Pedicle screw placement is a common procedure. Dr. Karikari is a consultant for NuVasive, Globus, Johnson & Johnson, and DePuy and receives a spine fellowship fund from NuVasive. (A) Anteroposterior and (B) lateral radiographs show coronal imbalance that developed 4 years after surgery in a 57-year-old woman with L3L4 float fusion. Neurosurgical experience with malpractice litigation: an analysis of closed claims against neurosurgeons in New York State, 1999 through 2003. These complications may have resulted from powerful bending movement acting on the screw at its entry point to the bone. 2020;162(6):13791387. All of these patients were asymptomatic and had satisfactory final clinical outcomes (Fig 2). Intraoperative pedicle fractures requiring further points of fixation. Hecht N, Kamphuis M, Czabanka M, et al. Bookshelf Mayo Clinic uses the latest robot-assisted technology when indicated to enhance surgical precision in these procedures. J Bone Joint Surg 61A:201207, 1979. The rate of reoperation for screw misplacement per screw was 0.17%. Summary of background data: 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. In situ spine arthrodesis permits load sharing by the vertebral bodies, preventing fatigue failure of the implant. Defensive medicine in U.S. spine neurosurgery. 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. Jena AB, Seabury S, Lakdawalla D, Chandra A. However, only a few complications were related to a poor clinical outcome. Clin Orthop 115:130139, 1976. FOIA 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. Deyo RA, Mirza SK, Martin BI. haroinfather roblox id 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. This study has shown that percutaneous insertion of pedicle screws in the lumbar spine is a safe and reliable technique, and despite the low misplacement rate of only 6.6%, it should be kept in mind that the surgical procedure is technically demanding and should be performed only by experienced spine surgeons. To evaluate the accuracy of pedicle screw placement using a novel classification system to determine potentially significant screw misplacement. 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. Careers. 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. True accuracy of percutaneous pedicle screw placement in thoracic and The initial search using the terms above returned 3654 cases. Incidence and costs of defensive medicine among orthopedic surgeons in the United States: a national survey study. Drs. 13 Whitecloud et al 35 reported 15% neurologic complications, 5% being caused by incorrect screw placement. Using Low-Dose, Biplanar Imaging to Reduce Screw Misplacement Please enable scripts and reload this page. Call me tomorrow. Two patients had an acute infection develop for which they required operative intervention with irrigation and debridement.
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