Nominal and inflation-adjusted award payouts were higher for trial verdicts than for settlement/arbitration, with a nominal average of $1,140,473 $841,683 versus $788,533 $306,186 awarded to the plaintiff, respectively (p = 0.30). 2022 Jun;8(2):234-241. doi: 10.21037/jss-22-28. 2013;123(9):20992103. Illinois Jury Finds in Favor of Doctor in Gallbladder Surgery that Led to Fatal Bowel Perforation Nickl v. Barry S. Rosen, M.D. 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%). Hsu K, Zucherman JF, White AH: Internal Fixation With Pedicle Screws. In situ spine arthrodesis permits load sharing by the vertebral bodies, preventing fatigue failure of the implant. Eur Spine J. Elizabeth Hofheinz, M.P.H., M.Ed. 36. leg pain. shooting in valdosta leaves one dead A neurologic deficit developed in one patient (0.9%) who had partial bilateral drop feet after reduction of L4L5 spondylolisthesis. The instrumentation and bone graft were left in place in these patients (total infection rate, 2.7%). Achieving proper lumbar lordosis, evaluating any preexisting scoliosis, and intraoperative assessment with AP radiographs could prevent balance problems. A retrospective review of charts, XRs and low-dose CT scans of 127 patients who underwent spinal fusion with pedicle screws for spinal deformity was performed. 2018;41(5):e615e620. Morphometric analysis of the proximal thoracic pedicles in Lenke II and IV adolescent idiopathic scoliosis: an evaluation of the feasibility for pedicle screw insertion. 15. Can Postoperative Radiographs Accurately Identify Screw Misplacements? Copyright 1944-2023 American Association of Neurological Surgeons, Copy this link, or click below to email it to a friend. Zdeblick TA: A prospective randomized study of lumbar fusion: Preliminary results. Rothberg MB, Class J, Bishop TF, et al. Materials and Methods Sixty . Dr. Friedlander did not order a CT or MRI until January 2013, when the pedicle screw was found to be in the wrong location and a failed fusion was diagnosed, according to the suit. 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. Clin Orthop 227:1023, 1988. Spine neurosurgeons facing the judicialization of their profession: disenchantment and alteration of daily practicea qualitative study. 18. Patient Suffers Permanent Nerve Damage From Spinal Surgery McAfee PC, Weiland DJ, Carlow JJ: Survivorship analysis of pedicle spinal instrumentation. 16,24,28 Simultaneously, the evolution of the surgical techniques has led to increased procedural safety. Your message has been successfully sent to your colleague. Fortunately, most of the complications were minor and transient. Nayar G, Blizzard DJ, Wang TY, et al. Ultimately, no significant differences in case demographics were found between plaintiff and defendant judgments (Table 1). There were two complete degenerations of the upper disc, one central canal stenosis, and two asymptomatic disc space narrowings and retrolistheses. Kreisman Law Offices has been handling Illinois surgical error lawsuits for individuals and families for more than 35 years in and around Chicago, Cook County and surrounding areas, including Batavia, Bellwood, Deerfield, Evanston, Franklin Park, and Lansing. Pedicle screw insertions are commonly used for posterior fixation to treat various spine disorders. 25. Lorenz M, Zindrick M, Schwaegler P, et al: A comparison of single level fusion with and without hardware. 2014;174(11):18671868. Of note, the award amount for one settlement case was undisclosed. Defendant-awarded cases by US region (right). 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. 2018;27(9):23392347. Drs. Medical malpractice litigation has made a significant impact on spine surgery, with many spine surgeons avoiding complex cases or practicing other defensive medicine tactics in an effort to avoid being sued.5 Moreover, the majority of neurosurgeons spend more than 10% of their annual revenue on malpractice insurance,1,14 and the excessive financial risk of litigation is even leading some insurers to no longer offer coverage to spine surgeons.19 A 2011 study in the New England Journal of Medicine found that 19.1% of neurosurgeons are named as a defendant in a malpractice suit each year (highest of any specialty).12 Moreover, 88% of physicians in high-risk specialties, like neurosurgery, are involved in a lawsuit by age 45, increasing to a concerning 99% by 65 years of age.12 Such litigation places a substantial financial, temporal, and emotional burden on physicians in high-risk specialties, with studies showing that up to 72% of neurosurgeons1 admitted that their fear of litigation significantly influenced their practice,25 with many avoiding high-risk patients altogether.1 Similarly, Nahed et al. 3. 1,12,19,22 The largest series of adjacent segment breakdown was reported by Schlegel et al. Erwin WD, Dickson JH, Harrington PR: Clinical review of patients with broken Harrington rods. 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. 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. Patient-specific 3D-printed surgical guides for pedicle screw insertion Spine 17:349355, 1992. 32. Among the plaintiff-awarded cases, 13 (61.9%) were decided by jury trial, 7 (33.3%) by settlement, and 1 (4.8%) by arbitration. Hardware problems were those related to the physical change of metal and screw position. Placement of thoracolumbar pedicle screws using three-dimensional image guidance: experience in a large patient cohort. 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. 13 Whitecloud et al 35 reported 15% neurologic complications, 5% being caused by incorrect screw placement. The accuracy rate of pedicle screw (PS) placement varies from 85% to 95% in the literature. There were no observed cases of screw misplacement outside the pedicle on routine AP and lateral radiographs. Dr. Abd-El-Barr is a consultant for Spineology. 2014;20(2):196203. In White AH, Rothman RH, Ray CD (eds). 2012;7(6):e39237. Hadjipavlou A, Enker P, Dupuis P, Katzman S, Silver J: The causes of failure of lumbar transpedicular spinal instrumentation and fusion: A prospective study. Use of the Airo mobile intraoperative CT system versus the O-arm for transpedicular screw fixation in the thoracic and lumbar spine: a retrospective cohort study of 263 patients. 2009;10(1):3339. Neurosurgeons and orthopedic surgeons were named as the defendant in an equal number of cases, and the decision for the plaintiff versus the defendant was also similar between specialties. 37. Plaintiff-awarded cases by US region (left). 4. Partner, Paul M. da Costa, Obtains $4.5 Million Verdict - Snyder Sarno 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. Clin Orthop 203:4553, 1986. Malpractice issues in neurological surgery. (PDF) Accuracy of pedicle screw placement in the lumbosacral spine Schlegel JD, Smith JA, Schleusener RN: Lumbar motion segment pathology adjacent to thoracolumbar, lumbar, and lumbosacral fusions. Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina; and, Malpractice liability and defensive medicine: a national survey of neurosurgeons, Defensive medicine among high-risk specialist physicians in a volatile malpractice environment, Defensive medicine: a culprit in spiking healthcare costs, Incidence and costs of defensive medicine among orthopedic surgeons in the United States: a national survey study, Defensive medicine in U.S. spine neurosurgery, Personal consequences of malpractice lawsuits on American surgeons. Please enable scripts and reload this page. 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. The medical malpractice suit Ayala v. Friedlander, M.D., claimed that a March 2011 lumbar fusion surgery performed by neurosurgeon Marvin Friedlander, MD, and orthopedic spine surgeon Douglas Bradley, MD, strayed from the accepted standards of care because a pedicle screw was placed in the wrong location. 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). 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). Routine CT scans were taken in all patients. Clin Orthop 203:717, 1986.