Illinois Jury Finds in Favor of Doctor in Gallbladder Surgery that Led to Fatal Bowel Perforation Nickl v. Barry S. Rosen, M.D. Preparation. Two patients had an acute infection develop for which they required operative intervention with irrigation and debridement. 38. One common area for the potential avoidance of malpractice claims and subsequent payouts involves misplaced pedicle and/or lateral mass instrumentation. Epstein NE. Nottmeier EW, Seemer W, Young PM. 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. The site is secure. 2014;174(11):18671868. Clin Orthop 227:1023, 1988. Statistical analysis: Sankey. George Sapkas, MD, DSc; and Panayiotis J. Papagelopoulis, MD, DScGuest Editors. Mason A, Paulsen R, Babuska JM, et al. The patient had subsequent coronal imbalance and degeneration of the upper disc. Epub 2021 Aug 28. 3. 2013;32(1):111119. Nevertheless, research has shown that screws are misplaced in approximately 14%55% of cases using the standard techniques (freehand and 2D fluoroscopic guidance) employed by most spine surgeons,21,33 resulting in injury in approximately 1%8% of cases.21 In addition to the avoidable procedural risk to the patient, each misplaced screw carries the threat of future litigation, as reported above. Malpractice risk according to physician specialty. HHS Vulnerability Disclosure, Help Clin Orthop 284:8090, 1992. 2018;29(4):397406. Instead, the defense offered up an alternative explanation for Nyquists foot drop. 2. 20. Spine J. While the majority of verdicts are found in favor of the defendant (surgeon), over 30% of cases in this study were found in favor of the plaintiff (patient), resulting in average inflation-adjusted payouts of over $1.2 million per claim over the past 25 years. Malpractice litigation and the spine: the NHS perspective on 235 successful claims in England. The third surgical procedure removed the pedicle screws but left the patient in an unfused state with an unstable spine. The rate of misplaced pedicle screws ranges from 1.1% to 28.8%, 10 although neurologic injury from misdirected pedicle screws has been reported to occur in 0% to 12% of patients. Luque ER: Segmental spinal instrumentation of lumbar spine. Your current browser may not support copying via this button. Eur Spine J. 2. Copyright 1944-2023 American Association of Neurological Surgeons, Copy this link, or click below to email it to a friend. 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. 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. Thirty-five (27.56%) had IMP and 18 (14.17%) had SAR. and transmitted securely. Screws were divided into four categories: screws at risk (SAR), indeterminate misplacements (IMP), benign misplacements (BMP), accurately placed (AP). Cases involving wrong-level or -side surgery, implant malfunction, or other misplaced spinal instrumentation (e.g., interbody cases, rods, surgical instruments, etc.) (A) Anteroposterior and (B) lateral radiographs taken 2 years after surgery show unilateral pseudarthrosis in a 55-year-old man with spinal stenosis. This study quantifies the rate of screw misplacement on a per-patient basis to highlight its effect on potential morbidity. 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. ABSTRACT: Pedicle screw loosening has been implicated in recurrent back pain after lumbar spinal fusion, but the degree of loosening has not been systematically quantied in patients. Spine (Phila Pa 1976). Mukherjee S, Pringle C, Crocker M. A nine-year review of medicolegal claims in neurosurgery. Judgment information associated with a defendant (surgeon) versus plaintiff (patient) ruling, trial versus settlement versus arbitration decision, award amount, and time to decision or case closure from index surgery was also recorded. 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. Problems at the junctions of the instrumented spine were seen in five patients (4.5%). Schatlo B, Molliqaj G, Cuvinciuc V, et al. 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. It is an effective procedure in that it provides an almost immediate stabilization of the spine [ 2-5 ]. Therefore, when instrumentation is to be used, the benefits must outweigh the risks. Facebook Google Plus Youtube RSS Email. 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. From the *Department of Orthopaedic Surgery, University of Crete Medical School, Heraklion, Greece; and the **First Department of Orthopaedics, University of Athens Medical School, Athens, Greece. General complications were considered those developing during and after surgery that were not directly related to instrumentation. Study supervision: Goodwin, Karikari, Shaffrey, Abd-El-Barr, KD Than. 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. Examples of both laterally and medially misplaced lumbar pedicle screws are provided in Fig. 13 Whitecloud et al 35 reported 15% neurologic complications, 5% being caused by incorrect screw placement. Operative information including fusion level, number of levels fused, level of misplaced screw(s), single versus multiple misplaced screw(s), presence of known CSF leakage, and primary injury due to screw misplacement was also collected. A high-low agreement is a settlement in which a defendant agrees to pay the plaintiff a minimum recovery in exchange for the plaintiff agreeing to accept a maximum amount regardless of the trial's outcome. Abstract BACKGROUND CONTEXT Surgeons have increasingly adopted robotic-assisted lumbar spinal fusion due to indications that robotic-assisted surgery can reduce pedicle screw misplacement. Despite these failures, solid spinal arthrodesis was obtained in all patients. 2019;19(7):12211231. Careers. One of the common means of doing so is to place a screw into each of two adjacent spinal bones (vertebrae), and then a rod between them. Percentage of cases per US region (center). Spine neurosurgeons facing the judicialization of their profession: disenchantment and alteration of daily practicea qualitative study. 2021 Nov 26;22(1):986. doi: 10.1186/s12891-021-04860-y. Administrative/technical/material support: Mehta, Wang, KD Than. Epub 2022 Oct 29. Disclaimer. 2012;7(6):e39237. St Louis, CV Mosby 322327, 1987. Clin Orthop 203:7598, 1986. The standard imaging technique for pedicle screw insertion is two-dimensional images obtained from C-arm-type X-ray fluoroscopy. The majority of screws were misplaced in the lumbar spine for both plaintiff- and defendant-awarded cases (66.7% vs 57.4%, respectively, p = 0.564; Table 1). 32. One common area for the potential avoidance of malpractice claims and subsequent payouts involves misplaced pedicle and/or lateral mass instrumentation. It argued that the foot drop was unavoidable and due to the surgeons need to manipulate the right L5 nerve root in order to remove Nyquists herniated disc during the spinal fusion surgery. Orthop Trans 11:99, 1987. Jena AB, Seabury S, Lakdawalla D, Chandra A. The total number of reoperations for MPS and patient clinical data were obtained from medical records at each hospital. 26 They support that after a lengthy symptom-free period, segments next to a fused segment can break down and the segment next to the adjacent segment is almost as likely to break down as the adjacent segment. Call me tomorrow. Complete degeneration of the upper disc developed in two patients who had spinal stenosis and degenerative scoliosis. 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. 2014 Aug 1;14(8):1702-8. doi: 10.1016/j.spinee.2014.03.044. 3). sharing sensitive information, make sure youre on a federal These risks can be minimized by the judicious use of instrumentation by experienced surgeons for specific indications as supported by the literature. Twenty-one patients (18.8%) had thoracolumbar injuries, and loss of immediate postoperative deformity correction ranged from 1.4 to 4.5. Mayo Clinic uses the latest robot-assisted technology when indicated to enhance surgical precision in these procedures. Critically revising the article: all authors. What can spine surgeons do to improve patient care and avoid medical negligence suits? Also notable, only one claim reported the use of intraoperative CT and was ultimately ruled in favor of the defendant. Schlegel JD, Smith JA, Schleusener RN: Lumbar motion segment pathology adjacent to thoracolumbar, lumbar, and lumbosacral fusions. Three-dimensional printing versus freehand surgical techniques in the surgical management of adolescent idiopathic spinal deformity. Under the high-low agreement, Drs. Spine 13:696706, 1988. All the operations were done by one surgeon (PK). Comparetto, Esq., 727-328-7900, www.florida-malpractice-lawyers.com. 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. 2021 Nov;9(6):1541-1548. doi: 10.1007/s43390-021-00377-5. Instrumentation removal is an option for patients with successful arthrodesis, but remains controversial. The patient had to undergo a subsequent surgery to remove the pedicles. Copyright © 2023 Becker's Healthcare. 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. South Med J 62:17, 1969. Cookie Policy. A CT scan was taken to try and identify the underlying neurological problem that might be causing the new symptom. Brodsky AE: Post-laminectomy and post-fusion stenosis of the lumbar spine. pedicle screws sagittal alignment spinal fusion surgical guides Spinal fusion is used to treat a range of conditions associated with spinal column such as intervertebral disc degeneration and scoliosis [ 1 ]. Pedicle screw insertions are commonly used for posterior fixation to treat various spine disorders, deformities, and trauma. Spine 19:25842589, 1994. When adjusted for inflation, these values increased to $1,330,201 $882,023 versus $970,832 $381,619, respectively (p = 0.32; Fig. matte black square deadbolt; roberts point park fishing report; qr code on binax covid test; mff premium character list. Spine 13:10121018, 1988. McAfee PC, Weiland DJ, Carlow JJ: Survivorship analysis of pedicle spinal instrumentation. J Neurosurg Spine. Legal liability in iatrogenic orbital injury. A misplacement rate of more than 20 % (129 misplaced screws out of 608) seems to be unacceptable compared to only 4.5 % misplacements when using CT-navigation leading to the conclusion that pedicle screw instrumentation in the middle and upper thoracic area should be carried out with the help of navigation only. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. Zucherman J, Hsu K, Picetti III G, et al: Clinical efficacy of spinal instrumentation in lumbar degenerative disc disease. 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. 37. Mean amounts awarded SD to plaintiffs by jury trial (n = 13) versus settlement/arbitration (n = 7), adjusted for inflation as of April 2020. Neurosurgical experience with malpractice litigation: an analysis of closed claims against neurosurgeons in New York State, 1999 through 2003. Potential complications may include increased pain, infection, or mechanical . Litigation resulted in average payouts of $1,204,422 $753,832 between 1995 and 2019, when adjusted for inflation. It has a great developing technique that is used for fixation and fusion in spine surgery. Pedicle screws are used by spine surgeons as part of a fusion in which two adjacent bones in the spine are combined together as one. Conception and design: Sankey, KD Than. This patient recovered completely in 6 weeks. L3S1 spine arthrodesis was done in the first patient but the correction of scoliosis was not sufficient and coronal imbalance persisted after surgery, which accelerated the degeneration of the level just above the arthrodesis. National Library of Medicine Din RS, Yan SC, Cote DJ, et al. They both had motor deficits from which 1 patient recovered completely. 1. Reviewed submitted version of manuscript: all authors. To evaluate the accuracy of pedicle screw placement using a novel classification system to determine potentially significant screw misplacement. laterally placed screws and the azygous vein on the right (T5-T11). Harris RI, Wiley JJ: Acquired spondylolysis as a sequel to spine fusion. Retrospective analysis of reasons and revision strategy for failed thoracolumbar fracture surgery by posterior approach: a series of 31 cases. Excessive hemorrhage occurred in two patients (1.8%) with coagulation disorders. Bydon M, Xu R, Amin AG, et al. $ = US$; MW = Midwest; NE = Northeast; SE = Southeast; SW = Southwest; W = West. Nahed BV, Babu MA, Smith TR, Heary RF. 2017;27(4):470475. Please try again soon. Results: 3,4,9,29,34 In addition, developments in surgical technique and implant design have decreased operative risk and implant-related complications. doi: 10.1097/BRS.0b013e31822a2e0a. Please try after some time. 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. Lehmann TR, LaRocca HS: Repeat lumbar surgery: A review of patients with failure from previous lumbar surgery treated with spinal canal exploration and lumbar spine fusion. Pediatric pedicle screw placement using intraoperative computed tomography and 3-dimensional image-guided navigation. Pedicle screw placement is a common procedure. 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). 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. Malpractice litigation following spine surgery. 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. 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). Long spine fixation was necessary for patients with tuberculous spondylitis and metastatic disease. + 48 696 042 504. Accuracy of C2 pedicle screw placement using the anatomic freehand technique. 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 However, the misplacement of pedicle screws can lead to disastrous complications because of the close proximity to neural tissue and the surrounding vessels, although rare, serious complications have been reported, such as dural tear, nerve-root irritation, neural injury . 2009;10(1):3339. Malpractice claims in spine surgery in Germany: a 5-year analysis. Neurosurgery. Epstein NE. 4). A retrospective review of charts, x-rays (XRs) and computed tomography (CT) scans was performed. In addition, the median time to judgment is substantial, particularly for defendant verdicts, spanning over 4.5 years from the time of surgery. Incidence and costs of defensive medicine among orthopedic surgeons in the United States: a national survey study. Nyquist had requested the defendants offer, which in retrospect was perhaps a poor decision in light of the Kane County jurys verdict. Defensive medicine: a culprit in spiking healthcare costs. However, following the spinal fusion, Nyquist began to experience foot drop in her right foot. Neurosurgery. 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. 2018;83(5):9971006. A total of 69 patients (mean age, 67.416 . The link was not copied. Am J Transl Res. A retrospective review of closed medicolegal cases with verdicts or settlements between 1995 and 2019 was performed using the Westlaw Edge legal research database (Thomson Reuters).7,14,16,23,24 A search of closed federal and state malpractice claims within the Verdicts and Settlements section consisted of the following: spine and surgery and pedicle and screw and fusion and (misplaced or misguided or mispositioned) and surgeon. Inclusion criteria consisted of malpractice claims against surgeons for complications related to misplaced pedicle and/or lateral mass screws. 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. 2014;96(4):266270. Spine 24:23522357, 1999. PMC 2016;102(2):358362. Pedicle screw fixation is commonly used in spinal instrumentation surgeries to connect rods to vertebrae in order to correct spine alignment, stabilize vertebrae, and reach an arthrodesis. Federal government websites often end in .gov or .mil. 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). Br J Neurosurg. 18. Some error has occurred while processing your request. Dr. K. D. Than is a consultant for Bioventus and receives honoraria from DJO and LifeNet Health. Plaintiff-awarded cases by US region (left). Dalenberg DD, Asher MA, Robinson RG, Jayaraman G: The effect of a stiff spinal implant and its loosening on bone mineral content in canines. It should be used by experienced and qualified surgeons who are familiar with the pitfalls associated with its use. 27. Debate Over Extent of Eye Damage Following Implant Lens Surgery Leads to $1 Million Verdict in Zaleski v Elmhurst Eye Surgery Center. Although the rationale for using pedicle screw fixation is fairly clear, controversy continues regarding the application of pedicle instrumentation for spine arthrodesis, especially on the degenerative lumbar spine. 8. States were then grouped by US region and case year by 5-year intervals. Dr. K. D. Than is a consultant for Bioventus and receives honoraria from DJO and LifeNet Health. This study revealed an overall accuracy rate of 95.2% of mainly percutaneously inserted pedicle screws according to the classification of Zdichavsky et al. Please enable scripts and reload this page. Epub 2014 Apr 4. Spine (Phila Pa 1976). ObjectThe goal of this study was to determine the incidence of screw misplacement and complications in a group of 102 patients who underwent transpedicle screw fixation in the lumbosacral spine with conventional open technique and intraoperative. Rovit RL, Simon AS, Drew J, et al. Clin Orthop 203:126134, 1986. Amount awarded to plaintiffs by US region, adjusted for inflation as of April 2020. 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. All the incidental dural tears were repaired immediately and produced no clinical sequelae. 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. 2020;162(6):13791387. Spinal fusion in the United States: analysis of trends from 1998 to 2008. 2007;106(6):11081114. 1. Rajasekaran S, Bhushan M, Aiyer S, et al. Drs. 13 Whitecloud et al 35 reported 15% neurologic complications, 5% being caused by incorrect screw placement. Objective: 2013;123(9):20992103. A review of medicolegal malpractice suits involving cervical spine: what can we learn or change? 12. Roy-Camille R, Roy-Camille M, Demeulenaere C: Osteosynthese du rachis dorsal, lombaire et lombo-sacre par plaque metalliques vissees dans les pedicules vertebraux et es apophyses articularies. Ann Thorac Surg. 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. Procedural errors led to combined payouts totaling $124,943,933 in neurosurgery claims between 2003 and 2012 in a study looking at data from the Physician Insurers Association of America Data Sharing Project.10 However, our study is the first to report the direct medicolegal impact of screw misplacement on US spine surgery, with 30.9% of judgments/settlements in favor of the plaintiff, resulting in average payouts of $1,204,422 $753,832 per claim. Using chi square analysis, statistically significant correlation was seen between disc space narrowing and loss of postoperative correction (p < 0.01). J Am Coll Surg. Placement of the pedicle screws in the thoracolumbar and lumbar spine is a technically demanding procedure. A TLIF is a surgical procedure that attempts to fuse vertebrae in order to stabilize the patient's spine. Spinal fusion procedures are increasingly performed each year, with Deyo et al. Can Postoperative Radiographs Accurately Identify Screw Misplacements? Thus, meaningful efforts to limit the rate of misplaced pedicle and lateral mass screws, such as the routine use of intraoperative imaging confirmation and/or computer- or robot-assisted navigation, should be carefully considered. Submitting a contact form, sending a text message, making a phone call, or leaving a voicemail does not create an attorney-client relationship. shooting in valdosta leaves one dead Please do not include any confidential or sensitive information in a contact form, text message, or voicemail. Crawford MJ, Esses SI: Indications for pedicle fixation: Results of NASS/SRS faculty questionnaire: North American Spine Society and Scoliosis Research Society. McLaughlin WM, Donnelley CA, Yu K, Gillinov SM, Tuason DA. 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. 2020;11:38. Waddell G, Kummell EG, Lotto WN, et al: Failed lumbar disc surgery and repeat surgery following industrial injuries.