Cotrel Y, Dubousset J, Guillaumat M: New universal instrumentation in spinal surgery. 2017;27(4):470475. 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. Please try again soon. In the other patient, L4L5 float arthrodesis was done. 22. Problems of balance were coronal (scoliosis greater than 5 or trunk shift greater than 5 mm) as seen on the AP radiograph taken with the patient standing or sagittal (failure to obtain or maintain lumbar lordosis). Administrative/technical/material support: Mehta, Wang, KD Than. Fishers exact test and the Mann-Whitney U-test were used for the analysis of categorical and continuous data, respectively, except when an unpaired t-test was utilized for analyses related to normalized, nominal, and inflation-adjusted award totals. Neurosurgical practice liability: relative risk by procedure type. 32. 1. The screws were needed to stabilize the spine and fix the fused vertebrae in place. In their meta-analysis of nine randomized controlled trials, Li et al. Neurosurgical experience with malpractice litigation: an analysis of closed claims against neurosurgeons in New York State, 1999 through 2003. Pediatric pedicle screw placement using intraoperative computed tomography and 3-dimensional image-guided navigation. (A) Anteroposterior and (B) lateral radiographs taken 2 years after surgery show unilateral pseudarthrosis in a 55-year-old man with spinal stenosis. A review of medicolegal malpractice suits involving cervical spine: what can we learn or change? Edmunds I, Cummine J, Fearnside M: Prevention of dislodgement of Cotrel-Dubousset rods from tulip screws. 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. Pedicle instrumentation in the thoracolumbar and lumbar spine is a technically challenging procedure. Smith TR, Hulou MM, Yan SC, et al. The average followup was 35 months (range, 1851 months). In the remaining patients, the standard construct was three-segment fixation spanning four vertebrae and three discs, two above and one below the fractured vertebra, using six screws. Would you like email updates of new search results? single homes for sale in lehigh valley, pa A.J. In two patients in the current series, dislodgement of the rods from tulip screws occurred, as reported originally by Edmunds et al. Intraoperative and postoperative complications were recorded by the authors and the results were evaluated by an independent observer. Nyquist had requested the defendants offer, which in retrospect was perhaps a poor decision in light of the Kane County jurys verdict. However, following the spinal fusion, Nyquist began to experience foot drop in her right foot. 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. Pedicle screw accuracy in thoracolumbar fractures- is routine 15. sharing sensitive information, make sure youre on a federal Clin Orthop 203:4553, 1986. Dr. Shaffrey has received grants from the NIH and Department of Defense. Zdeblick TA: A prospective randomized study of lumbar fusion: Preliminary results. The suit claimed Dr. Friedlander failed to diagnose and treat the mispositioned screw in a timely manner, leading the plaintiff to develop pain in his right leg, numbness in his right calf and weakness in his right toes. The cost of defensive medicine on 3 hospital medicine services, Defensive medicine in neurosurgery: the Canadian experience, Review of neurosurgery medical professional liability claims in the United States, A nine-year review of medicolegal claims in neurosurgery, Malpractice risk according to physician specialty, Neurosurgical experience with malpractice litigation: an analysis of closed claims against neurosurgeons in New York State, 1999 through 2003, Descriptive analysis of state and federal spine surgery malpractice litigation in the United States, Malpractice litigation following spine surgery, Medical malpractice in orthopedic surgery: a Westlaw-based demographic analysis, Malpractice claims in spine surgery in Germany: a 5-year analysis, On average, physicians spend nearly 11 percent of their 40-year careers with an open, unresolved malpractice claim, Malpractice litigation and the spine: the NHS perspective on 235 successful claims in England, Placement of thoracolumbar pedicle screws using three-dimensional image guidance: experience in a large patient cohort, It is easier to confuse a jury than convince a judge: the crisis in medical malpractice, Determining legal responsibility in otolaryngology: a review of 44 trials since 2008, Legal liability in iatrogenic orbital injury, Spine neurosurgeons facing the judicialization of their profession: disenchantment and alteration of daily practicea qualitative study, Malpractice issues in neurological surgery. Neurologic injury. A neurologic deficit developed in one patient (0.9%) who had partial bilateral drop feet after reduction of L4L5 spondylolisthesis. Several studies reveal that fusion rates increase when rigid internal fixation is used, 14,20,21,33,38 and that by using pedicle screws and plates or rods for stabilization, spinal arthrodesis can be limited to the disease segments. Routine CT scans were taken in all patients. Med Econ. Submitting a contact form, sending a text message, making a phone call, or leaving a voicemail does not create an attorney-client relationship. The rod is held in place by "pedicle screws," which the surgeon must insert into the pedicles. All these problems were observed only just above the upper instrumentation level and all were observed in patients older than 55 years. pedicle screw misplacement malpractice NCI CPTC Antibody Characterization Program. However, the misplacement of pedicle screws can lead to disastrous complications. Clin Orthop 284:8090, 1992. government site. Quraishi NA, Hammett TC, Todd DB, et al. 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. Pedicle screw fixation is an effective but demanding method to treat various spinal disorders and is associated with a significant complication rate. Lumbosacral pedicle screw placement using a fluoroscopic pedicle axis 9. Pedicle screw placement: Robotic assistance for greater precision N Engl J Med. Yuan et al 37 reported that the use of spinal instrumentation is associated with higher rate of infection (3%6%), neurologic injury (1%5%), instrumentation failure (6%10%), and reoperation (20%), compared with in situ arthrodeses. Adjusted for age and preoperative Cobb angle, patients with a higher misplacement rate were more likely to have screws . Results. It is an effective procedure in that it provides an almost immediate stabilization of the spine [ 2-5 ]. Can Postoperative Radiographs Accurately Identify Screw Misplacements? Katonis, Pavlos MD*; Christoforakis, Joseph MD*; Aligizakis, Agisilaos C. MD*; Papadopoulos, Charalampos MD*; Sapkas, George MD, DSc**; Hadjipavlou, Alexander MD*. 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. Litigation resulted in average payouts of $1,204,422 $753,832 between 1995 and 2019, when adjusted for inflation. You may be trying to access this site from a secured browser on the server. Rev Chir Orthop Reparatrice Appar Mot 62:151160, 1976. Pedicle screw insertion in the thoracolumbar spine. 16. Pedicle screw placement accuracy impact and comparison between grading Linking and Reprinting Policy. All the incidental dural tears were repaired immediately and produced no clinical sequelae. Clin Orthop 203:7598, 1986. Thus, we are unable to comment on whether all misplaced screws, particularly when asymptomatic, should be revised in an effort to prevent litigation. 2022 Dec;31(12):3544-3550. doi: 10.1007/s00586-022-07427-0. 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. Lawsuit information regarding the plaintiffs age at the time of the malpractice claim, sex, postoperative complaint, indication for index surgery, defendant surgeon specialty (neurosurgery vs orthopedics), and delayed diagnosis or treatment, as well as case location by state and case year, was obtained.