Pedicle screw insertion - AO Foundation NCI CPTC Antibody Characterization Program. J Pediatr Orthop. 2012;7(6):e39237. 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. Examples of both laterally and medially misplaced lumbar pedicle screws are provided in Fig. Long spine fixation was necessary for patients with tuberculous spondylitis and metastatic disease. 2022 Dec;31(12):3544-3550. doi: 10.1007/s00586-022-07427-0. A total of 2724 screws were placed in 127 patients. Seven hundred sixty-three screws were inserted in 138 patients. The instrumentation and bone graft were left in place in these patients (total infection rate, 2.7%). Recently, robot-assisted pedicle screw implantation has been increasingly utilized at large-volume academic centers. Hecht N, Kamphuis M, Czabanka M, et al. Per-patient analysis showed 23 (18.11%) of patients had all screws AP. Pitfall: Unstable injuries. Despite these failures, solid spinal arthrodesis was obtained in all patients. The standard imaging technique for pedicle screw insertion is two-dimensional images obtained from C-arm-type X-ray fluoroscopy. government site. The average followup was 35 months (range, 1851 months). Spine (Phila Pa 1976). Please enable scripts and reload this page. 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. All the operations were done by one surgeon (PK). General complications were considered those developing during and after surgery that were not directly related to instrumentation. Presse Med 78:14471448, 1970. Drs. Can Postoperative Radiographs Accurately Identify Screw Misplacements? J Neurosurg. With pedicle shapes and sizes varying wildly in the scoliotic spine, misplacement of a screwas well as and under- or oversizingare real possibilities in spine surgery. your express consent. First, this is a retrospective analysis of cases obtained from the web-based Westlaw Edge legal research database. 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. In addition, seven (6.3%) dural tears occurred during the decompression and none occurred during instrumentation. Unfortunately, the plaintiffs attorney was unable to offer an alternative theory of surgical negligence that would refute the defendants explanation. Spine 15:908912, 1990. The remaining eight patients, including two patients with spinal trauma, five patients with infection, and one patient with a tumor, had anterior and posterior procedures. Finally, considering the problems of balance, it seems that failure to properly evaluate any preexisting scoliosis was a main cause of this important complication. 2012;89(10):7071. Dr. Shaffrey has received grants from the NIH and Department of Defense. Spine neurosurgeons facing the judicialization of their profession: disenchantment and alteration of daily practicea qualitative study. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. 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 . McLaughlin WM, Donnelley CA, Yu K, Gillinov SM, Tuason DA. Sub-analysis of adolescent idiopathic scoliotic patients showed no curve or patient characteristic that correlated with IMP or SAR. These risks can be minimized by the judicious use of instrumentation by experienced surgeons for specific indications as supported by the literature. Except for the patient with an infected pseudarthrosis who had a flat back syndrome (sagittal imbalance) develop, coronal imbalance was observed in five patients (4.5%), and ranged from 7.5 to 12 (Fig 3). Under the high-low agreement, Drs.
Comparison of pedicle screw placement accuracy between two types of 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. As compared to cases in 19952009, those in 20102019 resulted in a significantly higher average nominal payout to plaintiffs ($776,439 $74,460 vs $1,506,000 $385,527, p = 0.028). Five patients had uneventful early postoperative course. The third surgical procedure removed the pedicle screws but left the patient in an unfused state with an unstable spine. Jena AB, Seabury S, Lakdawalla D, Chandra A. Unable to load your collection due to an error, Unable to load your delegates due to an error. Agarwal N, Gupta R, Agarwal P, et al. This was followed by pseudarthrosis requiring revision surgery, present in 14.3% (n = 3) and 14.9% (n = 7) of plaintiff- and defendant-awarded cases, respectively (p = 0.99). 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. Rev Chir Orthop Reparatrice Appar Mot 62:151160, 1976. Lumbar Spine Surgery. 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. 8. One common area for the potential avoidance of malpractice claims and subsequent payouts involves misplaced pedicle and/or lateral mass instrumentation. 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. 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. Clin Orthop 227:1023, 1988. Whitecloud III TS, Butler JC, Cohen JL, Candelora PD: Complications with the variable spinal plating system. 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 risk according to physician specialty. This step in implant evolution was inevitable, because prior phases of implant development did not control each plane of motion segment stress. 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. 27,30 Infected pseudarthrosis developed in one patient (0.9%) with an L4S1 arthrodesis, and the instrumentation was removed 18 months later resulting in a flat back syndrome. Analysis and interpretation of data: Sankey, TT Than. Roy-Camille R, Saillant G, Mazel C: Internal fixation of the lumbar spine with pedicle screw plating. Dr. Karikari is a consultant for NuVasive, Globus, Johnson & Johnson, and DePuy and receives a spine fellowship fund from NuVasive. In six of these patients with injuries at the thoracolumbar area (four patients with bent screws and two patients with broken screws), the loss of correction ranged from 3 to 4.5 without change of anatomic reduction (Fig 1). Friedlander and Bradley will pay half of the $2.25 million. A total of 2396 screws were placed accurately (87.96%). Spinal fusion procedures are increasingly performed each year, with Deyo et al. The accuracy rate of pedicle screw (PS) placement varies from 85% to 95% in the literature. 39. Dr. Abd-El-Barr is a consultant for Spineology. Bookshelf 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. Results: A total of 2724 screws were placed in 127 patients. Mean amounts awarded SD to plaintiffs by jury trial (n = 13) versus settlement/arbitration (n = 7), adjusted for inflation as of April 2020. There were 74 men and 38 women, with a mean age of 47 years (range, 1872 years). Rajaee SS, Bae HW, Kanim LE, Delamarter RB. 6 Clin Orthop 203:7598, 1986. Malpractice liability and defensive medicine: a national survey of neurosurgeons. to maintaining your privacy and will not share your personal information without
All Rights Reserved. The medicolegal landscape of spine surgery: how do surgeons fare? In addition, the median time to judgment is substantial, particularly for defendant verdicts, spanning over 4.5 years from the time of surgery.
Retrospective Computed Tomography Scan Analysis of Percutaneously 12. In 2 patients, misplacement of pedicle screws was recognized intraoperatively and all implants were removed. 32. pedicle screw: A rigid surgical implant used to stabilize adjacent spinal segments in spinal fusion surgery. Risk factor analysis showed smaller Cobb angles increased likelihood of all screws being AP. 6. Some error has occurred while processing your request. 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. The plaintiff will recover $2.25 million because of a high-low agreement the lawyers entered after closing arguments, the New Jersey Law Journal reports. Quraishi NA, Hammett TC, Todd DB, et al. Med Econ.
Pedicle screw replacement in spinal surgery - The MDU Fortunately, most of the complications were minor and transient. 2. Malpractice claims in spine surgery in Germany: a 5-year analysis. These complications may have resulted from powerful bending movement acting on the screw at its entry point to the bone. 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.