Patient safety: disclosure of medical errors and risk mitigation, Neurosurgical practice liability: relative risk by procedure type. JAMA. Spine Deform. Crawford MJ, Esses SI: Indications for pedicle fixation: Results of NASS/SRS faculty questionnaire: North American Spine Society and Scoliosis Research Society. Unable to load your collection due to an error, Unable to load your delegates due to an error. (A) Anteroposterior and (B) lateral radiographs taken 1 year after surgery show upper screw breakage in the application of a short Cotrel-Dubousset construct in a T12 burst fracture. $ = US$. 1. 2021 Nov;9(6):1541-1548. doi: 10.1007/s43390-021-00377-5. Screws were divided into four categories: screws at risk (SAR), indeterminate misplacements (IMP), benign misplacements (BMP), accurately placed (AP). Roy-Camille R, Saillant G, Mazel C: Internal fixation of the lumbar spine with pedicle screw plating. In unstable injuries, the segments above and below the level of injury may have a different orientation of the pedicle trajectory due to . Thankfully, most screws are just misplaced by a millimeter or two out the front or are slightly off medially, so they are not doing real damage. West et al 33 also reported a 29% complication rate for the first 50 patients and a 26% complication rate for the last 74 patients. Pedicle instrumentation in the thoracolumbar and lumbar spine is a technically challenging procedure. All Rights Reserved. George Sapkas, MD, DSc; and Panayiotis J. Papagelopoulis, MD, DScGuest Editors. Rajasekaran S, Bhushan M, Aiyer S, et al. Orthopedics. Author links open overlay panel Mohamad Bydon a b 1, Dimitrios Mathios a b 1, Mohamed Macki a b, Rafael De la Garza-Ramos a b, Nafi Aygun c, Daniel M. Sciubba a, Timothy F. Witham a, Ziya L. Gokaslan a b, Ali Bydon a b, Jean-Paul Wolinksy a. J Neurosurg Spine. Summary of background data: What can spine surgeons do to improve patient care and avoid medical negligence suits? In 2 patients, misplacement of pedicle screws was recognized intraoperatively and all implants were removed. 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. Defendant-awarded cases by US region (right). 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). Spine 18:23252326, 1993. GraphPad Prism version 6.01 for Windows was used for all descriptive analyses (GraphPad Software). 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. Excessive hemorrhage occurred in two patients (1.8%) with coagulation disorders. Deyo RA, Mirza SK, Martin BI. Clin Orthop 203:7598, 1986. Per-patient analysis reveals more concerning numbers toward screw misplacement. 2. 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. Of note, the award amount for one settlement case was undisclosed. 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. All the operations were done by one surgeon (PK). I won't be at the office but I will check my voice mail. 2017;42(3):177185. 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 ]. (A) Anteroposterior and (B) lateral radiographs taken 2 years after surgery show unilateral pseudarthrosis in a 55-year-old man with spinal stenosis. Two patients with associated injuries in the lower limbs had deep venous thrombosis develop, three patients had pneumonia develop, and four patients with neurologic impairment had urinary tract infections develop. 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. Results: A total of 2724 screws were placed in 127 patients. 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%). Characteristics of medicolegal cases related to misplaced screws in spine surgery. The accuracy of pedicle screw placement using intraoperative image guidance systems. The case facts centered on a spinal surgery the 34 year-old plaintiff had undergone at Central DuPage Hospital. Risk factor analysis showed smaller Cobb angles increased likelihood of all screws being AP. Cookie Policy. The rod is held in place by "pedicle screws," which the surgeon must insert into the pedicles. 5-7 Materials and Methods This is a retrospective study of kyphotic spondylitis tuberculosis (Stb) patients conducted at Fatmawati General Hospital, Jakarta, Indonesia, through the year 2020-2021. Your current browser may not support copying via this button. Spine (Phila Pa 1976). The initial search using the terms above returned 3654 cases. Malpractice litigation and the spine: the NHS perspective on 235 successful claims in England. Pedicle screw placement safety with the aid of patient-specific guides in a case series of patients with thoracic scoliosis. Edwards CC: Spinal screw fixation of the lumbar and sacral spine: Early results treating the first 50 cases. In the current study, no incidence of bent and broken screws or tulip screw plug dislodgement necessitated additional treatment, and all the patients achieved solid fusion despite the failure of instrumentation. Int Orthop 20:3542, 1996. A total of 247 screws (9.07%) were BMP, 52 (1.91%) were IMP, and 29 (1.06%) were considered SAR. 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. Mason A, Paulsen R, Babuska JM, et al. Subjects were 10,754 patients (73,777 pedicle screws) who underwent PSF at 11 hospitals over 15 years. In four of these patients, bent screws occurred at 8 to 10 months after surgery; in three patients, broken screw necks were seen 1 year after surgery and in two patients, tulip screw plug dislodgments were observed at 4 and 6 months postoperatively, respectively. Br J Neurosurg. J Neurosurg Spine. Amount awarded to plaintiffs by US region, adjusted for inflation as of April 2020. 8,24,25,32. 30. The site is secure. However, the medicolegal impact of misplaced screws on spine surgery has not been directly reported in the literature. Quraishi NA, Hammett TC, Todd DB, et al. The standard imaging technique for pedicle screw insertion is two-dimensional images obtained from C-arm-type X-ray fluoroscopy. Elsamadicy AA, Sergesketter AR, Frakes MD, Lad SP. Am J Otolaryngol. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. 3). 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. Spine 15:1114, 1990. Preparation. Breakage of a divergent screw of a Chopin block at the lumbosacral area was seen 3 months after surgery. Linking and Reprinting Policy. Problems in the instrumented segments were considered those occurring from narrowing of the disc space greater than 3 mm, pseudarthrosis, and loss of reduction. 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. Reviewed submitted version of manuscript: all authors. 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). Determining legal responsibility in otolaryngology: a review of 44 trials since 2008. $ = US$; MW = Midwest; NE = Northeast; SE = Southeast; SW = Southwest; W = West. In addition, seven (6.3%) dural tears occurred during the decompression and none occurred during instrumentation. 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). Whitecloud III TS, Butler JC, Cohen JL, Candelora PD: Complications with the variable spinal plating system. Segal J. Spine 19:25842589, 1994. Cases involving wrong-level or -side surgery, implant malfunction, or other misplaced spinal instrumentation (e.g., interbody cases, rods, surgical instruments, etc.) Two patients had early postoperative postural headache that disappeared after removal of the misplaced screw. The instrumentation and bone graft were left in place in these patients (total infection rate, 2.7%). Insuring spinal neurosurgery. J Bone Joint Surg 45A:11591170, 1963. 2018;28(2):186193. Drs. Fager CA. N Engl J Med. At the lumbosacral area, breakage of a divergent screw of a Chopin block occurred on only one side with no loss of correction. 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. 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. 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. 5. Scarone P, Vincenzo G, Distefano D, et al. Guzek RH, Mitchell SL, Krakow AR, Harshavardhana NS, Sarkissian EJ, Flynn JM. 2022 Sep 15;14(9):6323-6331. eCollection 2022. Disclosures Dr. Karikari is a consultant for NuVasive, Globus, Johnson & Johnson, and DePuy and receives a spine fellowship fund from NuVasive. Study supervision: Goodwin, Karikari, Shaffrey, Abd-El-Barr, KD Than. 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. 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 . NCI CPTC Antibody Characterization Program. Finally, considering the problems of balance, it seems that failure to properly evaluate any preexisting scoliosis was a main cause of this important complication. 2. 0 attorneys agreed. 20. Epstein NE. All of these patients were asymptomatic and had satisfactory final clinical outcomes (Fig 2). One common area for the potential avoidance of malpractice claims and subsequent payouts involves misplaced pedicle and/or lateral mass instrumentation. Spine neurosurgeons facing the judicialization of their profession: disenchantment and alteration of daily practicea qualitative study. 17. SECTION I SYMPOSIUM: Advances in Spine Surgery, Distribution of Spinal Disorders in 112 Patients, Classification of Complications in 64 patients. Illinois Jury Finds in Favor of Doctor in Gallbladder Surgery that Led to Fatal Bowel Perforation Nickl v. Barry S. Rosen, M.D. Erwin WD, Dickson JH, Harrington PR: Clinical review of patients with broken Harrington rods. Studies have shown that the greatest proportion of malpractice claims in spine surgery are related to procedural error,10,11,14,16,17,19 often resulting in the highest payouts.11,20 For spine surgery, one common area for the potential avoidance of malpractice claims and subsequent payouts involves misplaced pedicle and/or lateral mass screws, which occurs in approximately 14%55% of cases using standard techniques and results in neurological injury and/or durotomy in approximately 1%8% of cases.21 Misplaced screws have the potential to cause severe and sometimes permanent neurological deficits, including spinal cord and/or nerve root injury,21 as well as to decrease the stability of the fusion construct, leading to delayed complications related to pseudarthrosis. Examples of both laterally and medially misplaced lumbar pedicle screws are provided in Fig. Defensive medicine in neurosurgery: the Canadian experience. In order to prove medical malpractice occurred, the plaintiffs attorney needs to show not only the plaintiff experienced a poor medical outcome, but that it was directly caused by medical negligence. Spine arthrodesis was evaluated with plain AP and lateral radiographs taken 1 year after surgery. official website and that any information you provide is encrypted This device was used with an early version of the Cotrel-Dubousset instrumentation to provide sacral fixation and it is rarely used since the more widespread use of newer spine fixation systems. 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. Steinmann JC, Herkowitz HN: Pseudarthrosis of the spine. Spinal fusion procedures are increasingly performed each year, with Deyo et al. This site needs JavaScript to work properly. 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. Spine 18:18621866, 1993. Legal liability in iatrogenic orbital injury. Accessibility Comparetto, Esq., 727-328-7900, www.florida-malpractice-lawyers.com. 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. Don't jump in get legal help. A total of 69 patients (mean age, 67.416 . Dalenberg DD, Asher MA, Robinson RG, Jayaraman G: The effect of a stiff spinal implant and its loosening on bone mineral content in canines. Conclusion: However, following the spinal fusion, Nyquist began to experience foot drop in her right foot. When grouped by US region, most cases occurred in the Northeast (n = 25, 36.8%), followed by the West (n = 15, 22.1%; Fig. Plaintiff award amounts were adjusted for inflation as of April 2020 using an online inflation calculator provided by the US Bureau of Labor Statistics (https://www.bls.gov/data/inflation_calculator.htm). 36. Each case was then carefully screened for relevance and sufficient data. 3,4,9,29,34 In addition, developments in surgical technique and implant design have decreased operative risk and implant-related complications. [] Computer-assisted computed tomography (CT) techniques have improved the overall accuracy for pedicle screw placement, and has reduced complication rates. J Bone Joint Surg 54A:11951204, 1972. This retrospective study analyzes the complications and the problems developed during and after pedicle screw fixation in patients with spinal disorders and trauma. A CT scan was taken to try and identify the underlying neurological problem that might be causing the new symptom. Eur Spine J. Once the spine is exposed, the appropriate levels of fixation are confirmed with the image intensifier. Dr. Abd-El-Barr is a consultant for Spineology. 2013;34(6):699705. Copyright © 2023 Becker's Healthcare. Hecht N, Kamphuis M, Czabanka M, et al. Achieving proper lumbar lordosis, evaluating any preexisting scoliosis, and intraoperative assessment with AP radiographs could prevent balance problems. 23. None of these complications resulted in additional surgery or in a significant increase of morbidity. Dr. Karikari is a consultant for NuVasive, Globus, Johnson & Johnson, and DePuy and receives a spine fellowship fund from NuVasive. 27. Of the 112 patients, 57 patients had a lumbar degenerative disorder, (lumbar degenerative spinal canal stenosis in 23 patients, degenerative or spondylolytic spondylolisthesis in 12 patients, postlaminectomy instability or stenosis in 20 patients, and recurrent disc prolapse in two patients), 42 patients had spinal cord injury, eight patients had infection, and five patients had a spinal tumor (Table 1). A retrospective review of charts, x-rays (XRs) and computed tomography (CT) scans was performed. pedicle screw misplacement malpractice. However, the impact of robotic-assisted spinal fusion on patient outcomes is less clear. Despite this problem, the clinical result was excellent. Similarly, the highest inflation-adjusted amount awarded ($2,302,472) for pseudarthrosis was attributed to a medially breached pedicle screw during an L5S1 fusion that was determined to have caused the failed union and subsequent need for revision surgery. However, the highest offer had been a combined $300,000 from the two defendants. Neurosurgical practice liability: relative risk by procedure type. Rovit RL, Simon AS, Drew J, et al. What can spine surgeons do to improve patient care and avoid medical negligence suits? Harris RI, Wiley JJ: Acquired spondylolysis as a sequel to spine fusion. Yuan HA, Garfin SR, Dickman CA, Mardjetko SM: A historical cohort study of pedicle screw fixation in thoracic, lumbar and sacral spinal fusions. 2021 Nov 26;22(1):986. doi: 10.1186/s12891-021-04860-y. Spine 24:23522357, 1999. Mukherjee S, Pringle C, Crocker M. A nine-year review of medicolegal claims in neurosurgery. Studdert DM, Mello MM, Sage WM, et al. Pitfall: Unstable injuries. Your message has been successfully sent to your colleague. Defensive medicine in U.S. spine neurosurgery. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Cotrel Y, Dubousset J, Guillaumat M: New universal instrumentation in spinal surgery. 38. 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. [] The accuracy for free-hand screw placement technique varies from 69% to 94%. J Neurosurg Spine. A large number of studies have reported that in conventional thoracolumbar surgery, compared with traditional freehand screw placement, the accuracy of intraoperative pedicle screw placement has been improved with O-arm intraoperative navigation technology. Eur Spine J. 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). Reprint requests to Pavlos Katonis, MD, 99 Minoos & Thenon Street, 71305, Heraklion, Crete, Greece. Sethi MK, Obremskey WT, Natividad H, et al. Malpractice claims in spine surgery in Germany: a 5-year analysis. and transmitted securely. Disc space narrowing was the most common problem after instrumented arthrodesis and was observed in 27 patients (24.1%). 29. 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). laterally placed screws and the azygous vein on the right (T5-T11). Bydon M, Xu R, Amin AG, Macki M, Kaloostian P, Sciubba DM, Wolinsky JP, Bydon A, Gokaslan ZL, Witham TF. Patient safety: disclosure of medical errors and risk mitigation. PURPOSE This study aimed to compare rates of perioperative complications between robotic-assisted and conventional . One hundred four of the 112 patients had a posterior procedure. The rate of medical complications was 8%. Mohar J, Vali M, Podovovnik E, Mihali R. Eur Spine J. Feb. 16, 2021 Accurate placement of pedicle screws is key to avoiding the potential complications of spinal fusion surgery and improving overall spinal fixation. Thus, we are unable to comment on whether all misplaced screws, particularly when asymptomatic, should be revised in an effort to prevent litigation. 2013;32(1):111119. A total of 47 (69.1%) cases resulted in a decision for the defendant and 21 (30.9%) for the plaintiff. Ahmadi SA, Sadat H, Scheufler KM, et al. Copyright 1944-2023 American Association of Neurological Surgeons, Copy this link, or click below to email it to a friend. 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. 2002;27(22):24252430. PMC A neurologic deficit developed in one patient (0.9%) who had partial bilateral drop feet after reduction of L4L5 spondylolisthesis. Lorenz M, Zindrick M, Schwaegler P, et al: A comparison of single level fusion with and without hardware. 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. Plaintiff-awarded cases by US region (left). 2. 2016;124(5):15241530. There were no observed cases of screw misplacement outside the pedicle on routine AP and lateral radiographs. Hsu K, Zucherman JF, White AH: Internal Fixation With Pedicle Screws. Spine 8:970981, 1996. Federal government websites often end in .gov or .mil. The link was not copied. Categorical and continuous data are described as frequency (percentage) and median (interquartile range), respectively, except for the use of mean standard deviation for award amounts since both nominal and inflation-adjusted award totals passed (alpha = 0.05) the DAgostino-Pearson omnibus normality test. Fortunately, most of the complications were minor and transient. Rev Chir Orthop Reparatrice Appar Mot 62:151160, 1976. Plaintiff's expert was prepared to testify at trial that these complaints are characteristic of a malpositioned screw impinging upon a neural structure. 8600 Rockville Pike Clin Orthop 203:717, 1986. 2012;7(6):e39237. 1,12,19,22 The largest series of adjacent segment breakdown was reported by Schlegel et al. J Neurosurg Spine. 2014 Aug 1;14(8):1702-8. doi: 10.1016/j.spinee.2014.03.044. Koktekir E, Ceylan D, Tatarli N, Karabagli H, Recber F, Akdemir G. Spine J. Brodsky AE: Post-laminectomy and post-fusion stenosis of the lumbar spine. Statistical analysis: Sankey. 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. Screw misplacement. The rate of reoperation for screw misplacement per screw was 0.17%. Malpractice risk according to physician specialty. Similar to our findings, prior studies have shown that settlements result in lower payouts than cases that are ultimately taken to trial,7,14,15,30 with awards ranging from $125,000 to $9,000,000 compared to $134,000 to more than $38,000,000.7,15 Nevertheless, the true financial toll on spine surgery is largely unknown given that 85% of cases are dismissed or settled out of court, with undisclosed amounts.14 Likewise, substantial time is spent and costs, including legal and administrative, are incurred before judgment, as noted above. To investigate intraoperative reinsertion of percutaneous pedicle screw (PPS) with intraoperative CT-based navigation and to evaluate the rate of deviation of PPS at postoperative radiographic examination. Accuracy and workflow of navigated spinal instrumentation with the mobile AIRO CT scanner. Three-dimensional printing versus freehand surgical techniques in the surgical management of adolescent idiopathic spinal deformity. Defensive medicine: a culprit in spiking healthcare costs. Epstein NE. J Pediatr Orthop. J Neurosurg Spine. 2011;306(10):1088. 18. Pedicle screw insertions are commonly used for posterior fixation to treat various spine disorders, deformities, and trauma. West III JL, Bradford DS, Ogilvie JW: Results of spinal arthrodesis with pedicle screw-plate fixation. Krag MH, Beynnon BD, Pope MH, et al: An internal fixator for posterior application to short segment of the thoracic, lumbar, or lumbosacral spine. Results: doi: 10.1097/BRS.0b013e31822a2e0a. Zucherman J, Hsu K, Picetti III G, et al: Clinical efficacy of spinal instrumentation in lumbar degenerative disc disease. government site. Please enable scripts and reload this page. 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. The pedicle screw system is widely used in spine surgery, and it provides rigid fixation and leads to successful subsequent deformity correction and bony fusion. Edmunds I, Cummine J, Fearnside M: Prevention of dislodgement of Cotrel-Dubousset rods from tulip screws. 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. St Louis, CV Mosby 322327, 1987. Rajaee SS, Bae HW, Kanim LE, Delamarter RB. A p < 0.05 was considered statistically significant. Incidence and costs of defensive medicine among orthopedic surgeons in the United States: a national survey study. The last two patients had a T12L1 fracture-dislocation and a L4L5 spondylolytic spondylolisthesis at the site of plug dislodgments. 7. 16. Spine 6:615619, 1981. Objective: In the Kane County medical malpractice lawsuit of Melissa Nyquist v. Dr. Taras Masnyk and DuPage Neurosurgery, S.C., 06 L 421, the plaintiffs attorney was unable to convince the jury that the plaintiffs medical complications were caused by the defendants negligence. 1 Although this technique has advantages over open instrumentation, it also presents new challenges and specific complications. Per-patient analysis showed 23 (18.11%) of patients had all screws AP. Except for two patients with spinal metastatic disease, all other patients received an iliac crest autologous bone grafts. 37. Safety and efficacy of pedicle screw placement using intraoperative computed tomography: consecutive series of 1148 pedicle screws. These complications may have resulted from powerful bending movement acting on the screw at its entry point to the bone. It has a great developing technique that is used for fixation and fusion in spine surgery. 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.
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