Sub-analysis of adolescent idiopathic scoliotic patients showed no curve or patient characteristic that correlated with IMP or SAR. Schatlo B, Molliqaj G, Cuvinciuc V, et al. 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. It is an effective procedure in that it provides an almost immediate stabilization of the spine [ 2-5 ]. Copyright © 2023 Becker's Healthcare. Once the spine is exposed, the appropriate levels of fixation are confirmed with the image intensifier. Epub 2021 Aug 28. Quinnell RC, Stockdale HR: Some experimental observations of the influence of a single lumbar floating fusion on the remaining lumbar spine. Pedicle instrumentation in the thoracolumbar and lumbar spine is a technically challenging procedure. Over 40% of patients had screws with either some/major concern. 38. Can Postoperative Radiographs Accurately Identify Screw Misplacements? J Neurosurg Spine. Spine 16:576579, 1991. 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. 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Three slender patients complained of soft tissue irritation and a bothersome prominence because of the screws bulky profile. Examples of both laterally and medially misplaced lumbar pedicle screws are provided in Fig. Guillain A, Moncany AH, Hamel O, et al. Pedicle screw placement accuracy impact and comparison between grading Three-dimensional printing versus freehand surgical techniques in the surgical management of adolescent idiopathic spinal deformity. Screw Malposition: Are There Long-term Repercussions to Malposition of Pedicle Screws? Breakage of a divergent screw of a Chopin block at the lumbosacral area was seen 3 months after surgery. 33. Malpractice risk according to physician specialty. Whitecloud III TS, Butler JC, Cohen JL, Candelora PD: Complications with the variable spinal plating system. Malpractice litigation and the spine: the NHS perspective on 235 successful claims in England. Despite commonly used, questions remain about their safety especially for the thoracic spine and in deformity where difficulty in positioning can lead to pedicle breach and adjacent structures injury. $2 Million Spinal Surgery Case Against Neurosurgeon and Hospital Despite these failures, solid spinal arthrodesis was obtained in all patients. 8. Defendant-awarded cases by US region (right). Retrospective analysis of reasons and revision strategy for failed thoracolumbar fracture surgery by posterior approach: a series of 31 cases. PLoS One. J Neurosurg Spine. Twenty-one patients (18.8%) had thoracolumbar injuries, and loss of immediate postoperative deformity correction ranged from 1.4 to 4.5. Methods. 3). Hardware problems were those related to the physical change of metal and screw position. However, only a few complications were related to a poor clinical outcome. Luque ER: Segmental spinal instrumentation of lumbar spine. And while the offending screw was removed the next day, Nyquist continued to experience right foot drop, along with lower back pain and sciatica, i.e. Acquisition of data: Sankey. Svider PF, Husain Q, Kovalerchik O, et al. While the majority of claims are found to lack merit, resulting in a verdict in favor of the defendant or case dismissal,7,1316 at least 37% are considered valid.26 Regardless, payouts to plaintiffs are often substantial, averaging in the hundreds of thousands to millions of dollars in both the US and Europe.10,11,14,17,20 Communication of errors and expectations, thorough documentation, and selection of appropriate patients and surgical indications have been shown to reduce the likelihood of a successful malpractice claim.13,16,27,28 In addition, attempts at tort reform in some states have helped limit the financial burden of medical malpractice payouts through methods such as capitation.16,20,22,26 However, efforts to limit malpractice claims in the first place are greatly needed. Disclaimer. Median screw misplacement rate was 10% in group A and 13% in group B. Background The objective of this cadaveric study was to analyze the effects of iatrogenic pedicle perforations from screw misplacement on the mean pullout strength of lower thoracic and lumbar pedicle screws. 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. 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. (A) Anteroposterior and (B) lateral radiographs taken 2 years after surgery show unilateral pseudarthrosis in a 55-year-old man with spinal stenosis. Both of these patients complained of thigh pain but refused any additional surgery. Minimizing Pedicle Screw Pullout Risks: A Detailed Biomechan The median time to case closure was longer for defendant-awarded cases, but this finding was not statistically significant (61.5 vs 56.3 months, p > 0.05). Friedlander and Bradley will pay half of the $2.25 million. Level of evidence: [] Computer-assisted computed tomography (CT) techniques have improved the overall accuracy for pedicle screw placement, and has reduced complication rates. Cerebrospinal fluid fistulas. In this example, the surgeon replaced the misplaced screw prior to leaving the operating room, which arguably played a significant role in the jury ruling in favor of the defendant (surgeon). Plaintiff-awarded cases by US region (left). Morphometric analysis of the proximal thoracic pedicles in Lenke II and IV adolescent idiopathic scoliosis: an evaluation of the feasibility for pedicle screw insertion. Spine 17:349355, 1992. Please try again soon. Accessibility Spine (Phila Pa 1976). 2016;25(3):716723. Defensive medicine in U.S. spine neurosurgery. Placement of the pedicle screws in the thoracolumbar and lumbar spine is a technically demanding procedure. Bethesda, MD 20894, Web Policies Study design: There were nine instrumentation failures at the thoracolumbar area (seven patients), lumbar area (one patient), and lumbosacral area (one patient). In six patients (5.3%) with degenerative spine disease, the disc material had been removed. J Neurosurg Spine. Orthop Trans 11:99, 1987. pedicle screw misplacement malpractice 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. Rynecki ND, Coban D, Gantz O, et al. 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. Gertzbein SD, Robbins SE: Accuracy of pedicular screw placement in vivo. 2020;45(2):E111E119. Eur Spine J. Study supervision: Goodwin, Karikari, Shaffrey, Abd-El-Barr, KD Than. Rajaee SS, Bae HW, Kanim LE, Delamarter RB. The instrumentation and bone graft were left in place in these patients (total infection rate, 2.7%). Zucherman J, Hsu K, Picetti III G, et al: Clinical efficacy of spinal instrumentation in lumbar degenerative disc disease. Using Low-Dose, Biplanar Imaging to Reduce Screw Misplacement Malpractice liability and defensive medicine: a national survey of neurosurgeons. 2. All case demographics are summarized in Table 1. 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. Malpractice issues in neurological surgery. Ultimately, no significant differences were seen in inflation-adjusted award information between plaintiff and defendant (Table 3). Spine 6:263267, 1981. To reinforce spinal fixation, we have proposed a construct with segmental pedicle fixation two levels above and one level below the injured level and insertion of a screw deep into the pedicle, providing more contact area between screw head and bone and reducing the moment arm of the bending stress.