Inaccurate pedicle screw placement is relatively common even when placement is performed under fluoroscopic control. The development of the transpedicle screw has provided control of the vertebral motion segment in each plane, resisting any type of load. However, 5-10% of those misplaced screws are cause for concern." "To rectify this, we must have access to imaging devices during the procedure. Descriptive analysis of state and federal spine surgery malpractice litigation in the United States. J Neurosurg Spine. 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 most frequent primary injury listed for a lawsuit was nerve root injury, present in 81.0% (n = 17) and 74.5% (n = 35) of plaintiff- and defendant-awarded cases, respectively (p = 0.7). All case demographics are summarized in Table 1. Saillant G: Etude anatomique des pedicules vertebraux: Application chirurgicale. The plaintiff underwent revision surgery in May 2013. McLaughlin WM, Donnelley CA, Yu K, Gillinov SM, Tuason DA. Cookie Policy. The site is secure. 2. Hardware problems were those related to the physical change of metal and screw position. At the lumbosacral area, breakage of a divergent screw of a Chopin block occurred on only one side with no loss of correction. Except for two patients with spinal metastatic disease, all other patients received an iliac crest autologous bone grafts. Complications were classified as general, hardware-related, problems associated with the instrumented segments, junctional level problems, and problems related with balance (Table 2). The instrumentation and bone graft were left in place in these patients (total infection rate, 2.7%). The states with the most cases included California (n = 10, 14.7%), New York (n = 6, 8.8%), Pennsylvania (n = 6, 8.8%), and Illinois (n = 5, 7.3%; Table 2). These numbers are in line with the current literature. may email you for journal alerts and information, but is committed Spine (Phila Pa 1976). 2 One of the first obstacles regarding . 3,4,9,29,34 In addition, developments in surgical technique and implant design have decreased operative risk and implant-related complications. Previous biomechanical and clinical studies defining junctional segment problems are lacking and consist mainly of case reports. Clin Orthop 203:717, 1986. Unauthorized use of these marks is strictly prohibited. 36. Spine 17:834837, 1992. Clin Orthop 203:4553, 1986. In addition, studies have shown that over 85% of malpractice claims are either dismissed or settled out of court,14 which likely results in a high degree of underreporting. Svider PF, Husain Q, Kovalerchik O, et al. Another possible cause was the high lateral torques to the entire frame that occurred during tightening of the tulip screw. What can spine surgeons do to improve patient care and avoid medical negligence suits? single homes for sale in lehigh valley, pa single homes for sale in lehigh valley, pa Home Realizacje i porady Bez kategorii single homes for sale in lehigh valley, pa Pediatric pedicle screw placement using intraoperative computed tomography and 3-dimensional image-guided navigation. J Neurosurg Spine. 2021 Nov 26;22(1):986. doi: 10.1186/s12891-021-04860-y. Ultimately, no significant differences were seen in inflation-adjusted award information between plaintiff and defendant (Table 3). 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. 23. 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. 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. Personal consequences of malpractice lawsuits on American surgeons. A CT scan was taken to try and identify the underlying neurological problem that might be causing the new symptom. 6. 2022 Sep 15;14(9):6323-6331. eCollection 2022. Despite this problem, the clinical result was excellent. Thus, we are unable to comment on whether all misplaced screws, particularly when asymptomatic, should be revised in an effort to prevent litigation. Larson AN, Santos ER, Polly DW Jr, Ledonio CG, Sembrano JN, Mielke CH, Guidera KJ. Of note, the award amount for one settlement case was undisclosed. The total number of reoperations for MPS and patient clinical data were obtained from medical records at each hospital. Instead, the defense offered up an alternative explanation for Nyquists foot drop. Methods: Morphometric analysis of the proximal thoracic pedicles in Lenke II and IV adolescent idiopathic scoliosis: an evaluation of the feasibility for pedicle screw insertion. One of the patients had a late wound infection develop that was treated by radical debridement and removal of instrumentation. All the operations were done by one surgeon (PK). Reviewed submitted version of manuscript: all authors. 2014;20(2):196203. Steinmann JC, Herkowitz HN: Pseudarthrosis of the spine. 2018;27(9):23392347. However, only a few complications were related to a poor clinical outcome. 32. Health Aff (Millwood). Among the plaintiff-awarded cases, 13 (61.9%) were decided by jury trial, 7 (33.3%) by settlement, and 1 (4.8%) by arbitration. Smith TR, Hulou MM, Yan SC, et al. Mean amounts awarded SD to plaintiffs by jury trial (n = 13) versus settlement/arbitration (n = 7), adjusted for inflation as of April 2020. When adjusted for inflation, these values increased to $1,330,201 $882,023 versus $970,832 $381,619, respectively (p = 0.32; Fig. Rothberg MB, Class J, Bishop TF, et al. Presse Med 78:14471448, 1970. 2016;102(2):358362. All of these patients were asymptomatic and had satisfactory final clinical outcomes (Fig 2). Better strategies need to be devised for evaluation of screw placement, including establishment of a national database of deformity surgery, use of intra-operative image guidance, and reevaluation of postoperative low-dose CT imaging. Screws were divided into four categories: screws at risk (SAR), indeterminate misplacements (IMP), benign misplacements (BMP), accurately placed (AP). (%), Pseudarthrosis requiring revision surgery. Lumbar Spine Surgery. Br J Neurosurg. Clinical Orthopaedics and Related Research, Get new journal Tables of Contents sent right to your email inbox, The Association of Bone and Joint Surgeons, Complications and Problems Related to Pedicle Screw Fixation of the Spine, Articles in Google Scholar by Pavlos Katonis, MD, Other articles in this journal by Pavlos Katonis, MD, Privacy Policy (Updated December 15, 2022). 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. Rynecki ND, Coban D, Gantz O, et al. This decision must be made on a case-by-case basis at the surgeons and patients discretion after a thorough discussion of the associated risks and benefits of revision surgery. 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. Katonis PG, Kontakis GM, Loupasis GA, et al: Treatment of unstable thoracolumbar and lumbar spine injuries using Cotrel-Dubousset instrumentation. [] Computer-assisted computed tomography (CT) techniques have improved the overall accuracy for pedicle screw placement, and has reduced complication rates. to maintaining your privacy and will not share your personal information without Instrumentation removal is an option for patients with successful arthrodesis, but remains controversial. 22. Accessibility 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. This step in implant evolution was inevitable, because prior phases of implant development did not control each plane of motion segment stress. 33. Your current browser may not support copying via this button. 2018;29(4):397406. Spine (Phila Pa 1976). 2018;18(2):209215. Potential complications may include increased pain, infection, or mechanical . This patient recovered completely in 6 weeks. shooting in valdosta leaves one dead Pedicle screw accuracy in thoracolumbar fractures- is routine postoperative CT scan necessary? Neurosurgery. As part of the surgery, Dr. Taras Masnyk inserted four metal screws into the plaintiffs spine. Likewise, research shows that breaches still occur when these tools are used,33,40 and some studies did not find a difference in pedicle breach rates compared to those with traditional fluoroscopic and freehand techniques.33 Ultimately, misplaced instrumentation is a risk of any spinal fusion surgery, and a thorough discussion of these risks, as well as the alternative management options, is essential to maintain high-quality patient care and to avoid litigation. 27. pedicle screw misplacement malpractice. Spine 13:10121018, 1988. Spine 8:970981, 1996. Disclosures Dr. Karikari is a consultant for NuVasive, Globus, Johnson & Johnson, and DePuy and receives a spine fellowship fund from NuVasive.