2012;21(suppl 2):S196S199. Dr. K. D. Than is a consultant for Bioventus and receives honoraria from DJO and LifeNet Health. The third surgical procedure removed the pedicle screws but left the patient in an unfused state with an unstable spine. J Neurosurg Spine. The rate of medical complications was 8%. 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). Twenty-one patients (18.8%) had thoracolumbar injuries, and loss of immediate postoperative deformity correction ranged from 1.4 to 4.5. shooting in valdosta leaves one dead A TLIF is a surgical procedure that attempts to fuse vertebrae in order to stabilize the patient's spine. This study revealed an overall accuracy rate of 95.2% of mainly percutaneously inserted pedicle screws according to the classification of Zdichavsky et al. Achieving proper lumbar lordosis, evaluating any preexisting scoliosis, and intraoperative assessment with AP radiographs could prevent balance problems. In 2 patients, misplacement of pedicle screws was recognized intraoperatively and all implants were removed. 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. The physician ordered an MRI of the lumbar spine which showed that the screws had been misplaced and were puncturing the patient's lumbar nerves. 2018;18(2):209215. 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. Two-dimensional (2D) fluoroscopy-guided percutaneous pedicle screw (PPS) placement is currently the most widely applied instrumentation for minimally invasive treatment of spinal injuries requiring stabilization. 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. (%), Pseudarthrosis requiring revision surgery. Nottmeier EW, Seemer W, Young PM. Pitfall: Unstable injuries. Thirty-five (27.56%) had IMP and 18 (14.17%) had SAR. Among the plaintiff-awarded cases, 13 (61.9%) were decided by jury trial, 7 (33.3%) by settlement, and 1 (4.8%) by arbitration. In situ spine arthrodesis permits load sharing by the vertebral bodies, preventing fatigue failure of the implant. All Rights Reserved. PLoS One. Each side was judged separately. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. Todd NV. Edmunds I, Cummine J, Fearnside M: Prevention of dislodgement of Cotrel-Dubousset rods from tulip screws. Also notable, only one claim reported the use of intraoperative CT and was ultimately ruled in favor of the defendant. 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. $ = US$; MW = Midwest; NE = Northeast; SE = Southeast; SW = Southwest; W = West. Steffee AD, Biscup RS, Sitkowski DJ: Segmental spine plates with pedicle screw fixation: A new internal fixation device for disorders of the lumbar and thoracolumbar spine. Percentage of cases per US region (center). However, the impact of robotic-assisted spinal fusion on patient outcomes is less clear. Yuan HA, Garfin SR, Dickman CA, Mardjetko SM: A historical cohort study of pedicle screw fixation in thoracic, lumbar and sacral spinal fusions. Clipboard, Search History, and several other advanced features are temporarily unavailable. 30. 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. Spine 13:696706, 1988. 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;45(2):E111E119. Spine 8:970981, 1996. Pedicle screw placement safety with the aid of patient-specific guides in a case series of patients with thoracic scoliosis. 2016;102(2):358362. 2012 Feb 1;37(3):E188-94. 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. Orthop Trans 11:99, 1987. Although the rate of the reported medical complications was high (36.5%), these did not significantly affect the final clinical outcome of the current patients. In six patients (5.3%) with degenerative spine disease, the disc material had been removed. 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. We avoid using sharp automated drilling, and probe fully the pedicle cavity to prevent nerve root impairment. Guzek RH, Mitchell SL, Krakow AR, Harshavardhana NS, Sarkissian EJ, Flynn JM. Dr. Shaffrey has received grants from the NIH and Department of Defense. All Rights Reserved. 2014;21(3):320328. It has a great developing technique that is used for fixation and fusion in spine surgery. HHS Vulnerability Disclosure, Help 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. 2022 Jun;8(2):234-241. doi: 10.21037/jss-22-28. Analysis and interpretation of data: Sankey, TT Than. These risks can be minimized by the judicious use of instrumentation by experienced surgeons for specific indications as supported by the literature. The screws were needed to stabilize the spine and fix the fused vertebrae in place. And while the offending screw was removed the next day, Nyquist continued to experience right foot drop, along with lower back pain and sciatica, i.e. 2014 Sep;21(3):320-8. doi: 10.3171/2014.5.SPINE13567. Two patients had an acute infection develop for which they required operative intervention with irrigation and debridement. Katonis, Pavlos MD*; Christoforakis, Joseph MD*; Aligizakis, Agisilaos C. MD*; Papadopoulos, Charalampos MD*; Sapkas, George MD, DSc**; Hadjipavlou, Alexander MD*. First, this is a retrospective analysis of cases obtained from the web-based Westlaw Edge legal research database. The intent is to provide relief from pain and nerve damage. official website and that any information you provide is encrypted Hadjipavlou A, Enker P, Dupuis P, Katzman S, Silver J: The causes of failure of lumbar transpedicular spinal instrumentation and fusion: A prospective study. Spine surgery has been disproportionately impacted by medical liability and malpractice litigation, with the majority of claims and payouts related to procedural error. Moreover, several cases stated that the surgeon used only the anteroposterior or the lateral view, but not both, and the plaintiffs counsel used this information in support of their claim. 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. A CT scan was taken to try and identify the underlying neurological problem that might be causing the new symptom. 4. The jury found the defendants liable and allocated 75 percent of the fault to Dr. Friedlander and 25 percent to Dr. Bradley. On April 6, a Union County, N.J., jury awarded a plaintiff $4.5 million over a botched spine surgery. 2018;41(5):e615e620. Despite this problem, the clinical result was excellent. Of note, while only 38.2% (n = 26) of cases in our study mentioned the use of intraoperative radiographic confirmation, only one of these cases reported that the misplaced screw had been caught prior to leaving the operating room, which had resulted in an inadvertent dural tear and L5 nerve root injury. 3. 17. and transmitted securely. Pedicle screw instrumentation is widely used for the stabilization of the subaxial cervical, thoracic, and lumbar spine. Comparetto, Esq., 727-328-7900, www.florida-malpractice-lawyers.com. [] The accuracy for free-hand screw placement technique varies from 69% to 94%. Zucherman J, Hsu K, Picetti III G, et al: Clinical efficacy of spinal instrumentation in lumbar degenerative disc disease. Friedlander and Bradley will pay half of the $2.25 million. In the other patient, L4L5 float arthrodesis was done. Rather, the defense demonstrated that although the misplaced screw had in fact irritated the L4 nerve root for the six days before it was removed, the related symptoms resolved with the screws removal. 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. JAMA. A total of 2396 screws were placed accurately (87.96%). Some error has occurred while processing your request. Abstract BACKGROUND CONTEXT Surgeons have increasingly adopted robotic-assisted lumbar spinal fusion due to indications that robotic-assisted surgery can reduce pedicle screw misplacement. This demonstrates technical ability but does not represent the impact of screw misplacement on individual patients. Several studies have shown that spine surgery is at the highest risk for litigation among the surgical subspecialties.12,29 The majority of claims are related to technical and procedural errors,29 including misplaced pedicle and/or lateral mass screws. doi: 10.1097/BRS.0b013e31822a2e0a. 2016;124(5):15241530. Bydon M, Xu R, Amin AG, Macki M, Kaloostian P, Sciubba DM, Wolinsky JP, Bydon A, Gokaslan ZL, Witham TF. Privacy Policy. 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. 2020;162(6):13791387. 1 To be effective, the pedicle screw constructs must withstand intraoperative loading and physiological forces due to daily postoperative activities. J Neurosurg Spine. The medicolegal landscape of spine surgery: how do surgeons fare? It is easier to confuse a jury than convince a judge: the crisis in medical malpractice. Debate Over Extent of Eye Damage Following Implant Lens Surgery Leads to $1 Million Verdict in Zaleski v Elmhurst Eye Surgery Center. As part of the surgery, Dr. Taras Masnyk inserted four metal screws into the plaintiff's spine. Jena AB, Seabury S, Lakdawalla D, Chandra A. A Cotrel-Dubousset spinal system (Medtronic Sofamor Danek, Memphis, TN) was used in all patients and the total number of screws used was 658. Lorenz M, Zindrick M, Schwaegler P, et al: A comparison of single level fusion with and without hardware. 2011;306(10):1088. However, following the spinal fusion, Nyquist began to experience foot drop in her right foot. In addition, the median time to judgment is substantial, particularly for defendant verdicts, spanning over 4.5 years from the time of surgery. 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. The plaintiff underwent revision surgery in May 2013. 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. 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. Steffee AD, Brantigan JW: The variable screw placement spinal fixation system: Report of a prospective study of 250 patients enrolled in Food and Drug Administration clinical trials. In White AH, Rothman RH, Ray CD (eds). Dr. Abd-El-Barr is a consultant for Spineology. A total of 69 patients (mean age, 67.416 . Waddell G, Kummell EG, Lotto WN, et al: Failed lumbar disc surgery and repeat surgery following industrial injuries. Cookie Policy. 15. A retrospective review of charts, x-rays (XRs) and computed tomography (CT) scans was performed. Disclosures Dr. Karikari is a consultant for NuVasive, Globus, Johnson & Johnson, and DePuy and receives a spine fellowship fund from NuVasive. Copyright 1944-2023 American Association of Neurological Surgeons, Copy this link, or click below to email it to a friend. There were 74 men and 38 women, with a mean age of 47 years (range, 1872 years). 2017;27(4):470475. Larson AN, Santos ER, Polly DW Jr, Ledonio CG, Sembrano JN, Mielke CH, Guidera KJ. INCLUDE WHEN CITING DOI: 10.3171/2020.8.FOCUS20600. Conception and design: Sankey, KD Than. 20th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference, 8th Annual Health IT + Digital Health + RCM Conference, 29th Annual Meeting - The Business & Operations of ASCs, The issues spine surgeons are advocating for outside of the operating room, Centinel Spine is now covered by all major payers, What's next for SI joint fusion? Ultimately, no significant differences in case demographics were found between plaintiff and defendant judgments (Table 1). Li HM, Zhang RJ, Shen CL. Unauthorized use of these marks is strictly prohibited. Misplacement rates have been reported to be from 5 to 41% in the lumbar spine and from 3 to 55% in the . As part of the surgery, Dr. Taras Masnyk inserted four metal screws into the plaintiffs spine. 35. Disclaimer. FOIA Spine 17:349355, 1992. to maintaining your privacy and will not share your personal information without West III JL, Bradford DS, Ogilvie JW: Results of spinal arthrodesis with pedicle screw-plate fixation. A total of 247 screws (9.07%) were BMP, 52 (1.91%) were IMP, and 29 (1.06%) were considered SAR. Quinnell RC, Stockdale HR: Some experimental observations of the influence of a single lumbar floating fusion on the remaining lumbar spine. Rothberg MB, Class J, Bishop TF, et al. Feb. 16, 2021 Accurate placement of pedicle screws is key to avoiding the potential complications of spinal fusion surgery and improving overall spinal fixation. reporting that the number of Medicare patients who underwent a complex lumbar spine fusion for spinal stenosis increased 15-fold, from 1.3 persons per 100,000 Medicare persons in 2002 to 19.9 in 2007.31 Similarly, a study by Rajaee et al. 18. Many technological advances have been made over the past several decades in an effort to improve the accuracy of screw placement in spine surgery.3436 For example, 3D fluoroscopybased image guidance has been shown to decrease the pedicle breach rate in several studies compared to the rate with 2D fluoroscopic guidance or the freehand technique, particularly in deformity and revision surgeries.21,34,36,37 CT guidance or intraoperative confirmation has also been shown to further improve the accuracy of pedicle screw placement,3638 with reported accuracy rates of 89%100% reported in the literature, depending on the authors breach criteria.35 However, it is important to note that the use of this technology is often accompanied by a lower threshold for intraoperative screw revision, sometimes leading to higher rates of replaced screws.33 Arguably, these improved trajectories may avoid iatrogenic neurological deficits due to prolonged nerve root compression or even improve the stability of the construct;34,37 however, prospective studies of long-term outcomes and rates of revision surgery remain sparse in the literature. Epub 2022 Oct 29. The amount awarded was not significantly different across US regions (p = 0.9; Fig. 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. This site needs JavaScript to work properly. 23. Accuracy of fluoroscopically-assisted pedicle screw placement: analysis of 1,218 screws in 198 patients. Neurosurgical practice liability: relative risk by procedure type. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The cost of defensive medicine on 3 hospital medicine services. Adjusted for age and preoperative Cobb angle, patients with a higher misplacement rate were more likely to have screws . 1). 13 Whitecloud et al 35 reported 15% neurologic complications, 5% being caused by incorrect screw placement. Notwithstanding these concessions, the MDU argued that misplacement of pedicle screw tracts was common in surgery of this kind, even in experienced and competent hands. Disc space narrowing was the most common problem after instrumented arthrodesis and was observed in 27 patients (24.1%). Spine (Phila Pa 1976). Risk factor analysis showed smaller Cobb angles increased likelihood of all screws being AP. Johnston II CE, Ashman RB, Baird AM, Allard RN: Effect of spinal construct stiffness on early fusion mass incorporation: Experimental study. Show more. Additional survey data have shown that 50% of physicians exhibit at least a temporary loss of self-esteem after a malpractice claim, and at least 25% experience depression.22 As stated above, the average neurosurgeon spends 27.2% of his or her entire career in an open malpractice claim,10 and each case can take an average of 5.1, 5.0, and 3.4 years for defendant verdicts, plaintiff rulings, and settlements, respectively.7,15 Likewise, neurosurgeons have a higher risk than practitioners in other specialties of being named in multiple malpractice suits given the particularly high-risk nature of the specialty.10 Even when found in favor of the defendant (surgeon), each case ultimately takes a substantial emotional and financial toll on the physician(s) involved. 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. 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. 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). Reprint requests to Pavlos Katonis, MD, 99 Minoos & Thenon Street, 71305, Heraklion, Crete, Greece. Except for two patients with spinal metastatic disease, all other patients received an iliac crest autologous bone grafts. Spine (Phila Pa 1976). Review of neurosurgery medical professional liability claims in the United States. 2018;28(2):186193. The defense pointed to the lack of evidence that the screw had ever come into contact with the L5 nerve root. Another possible cause was the high lateral torques to the entire frame that occurred during tightening of the tulip screw. Copyright © 2023 Becker's Healthcare. This retrospective analysis of 68 closed medicolegal cases related to misplaced screws in spine surgery showed that neurosurgeons and orthopedic spine surgeons were equally named as the defendant (n = 32 and 31, respectively), and cases were most commonly due to misplaced lumbar pedicle screws (n = 41, 60.3%). 1. Harrington and Tullos 11 first reported the technique of transpedicle screw fixation, and Roy-Camille et al 23 popularized the first practical method of pedicle screw fixation. J Spine Surg. 8600 Rockville Pike Defensive medicine in neurosurgery: the Canadian experience. The site is secure. Introduction. The average age of the patients was 47 years and the average followup was 35 months. 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. Ahmadi SA, Sadat H, Scheufler KM, et al. J Bone Joint Surg 73A:11791184, 1991. 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. Epub 2021 Aug 28. 2. N Engl J Med. 11. Epstein NE. Accessibility Spine J. Both issues represent the most frequent and highest payouts in spine malpractice claims.10,14,22 While several studies have explored many of the factors related to malpractice claims in spine surgery, the medicolegal impact of misplaced pedicle and/or lateral mass screws has not been directly reported in the literature. Objective: 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. J Pediatr Orthop. Stauffer RN, Coventry MB: Posterolateral lumbar-spine fusion: Analysis of the Mayo clinic series. Pedicle screw construct have become one of the most practiced procedure in spinal surgery. 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. Spine 18:23252326, 1993. Mason A, Paulsen R, Babuska JM, et al. 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. However, this difference was no longer significant when adjusted for inflation ($1,016,000 $90,875 vs $1,630,000 $422,405, p = 0.09). Hardware-related failures were observed in 12 patients (10.7%). Rovit RL, Simon AS, Drew J, et al. The rod is held in place by "pedicle screws," which the surgeon must insert into the pedicles. Grubb SA, Lipscomb HJ: Results of lumbosacral fusion for degenerative disc disease with and without instrumentation: Two- to five-year follow-up. The case facts centered on a spinal surgery the 34 year-old plaintiff had undergone at Central DuPage Hospital. Accuracy of pedicle screw placement and clinical outcomes of robot-assisted technique versus conventional freehand technique in spine surgery from nine randomized controlled trials: a meta-analysis. Elizabeth Hofheinz, M.P.H., M.Ed. Ultimately, no significant differences were seen in inflation-adjusted award information between plaintiff and defendant (Table 3). Complications were classified as general, hardware-related, problems associated with the instrumented segments, junctional level problems, and problems related with balance (Table 2). 5. J Bone Joint Surg 62A:13021307, 1980. Please enable it to take advantage of the complete set of features! Before Brodsky AE: Post-laminectomy and post-fusion stenosis of the lumbar spine. I won't be at the office but I will check my voice mail. 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. 1 Although this technique has advantages over open instrumentation, it also presents new challenges and specific complications. 22. In the current study, the arthrodesis rate of 89.4% compares favorably with other previously reported series in the spinal literature, most of which use radiographic means to access the status of the spinal arthrodesis. 13 Whitecloud et al 35 reported 15% neurologic complications, 5% being caused by incorrect screw placement. Forty-seven intraoperative and medical complications were observed in 41 patients (36.6%). 2013;32(1):111119. Smith TR, Hulou MM, Yan SC, et al. Moreover, local court rulings are not included in the Westlaw Edge database; however, this is unlikely to present meaningful bias given that malpractice claims are generally filed in state courts. The accuracy rate of pedicle screw (PS) placement varies from 85% to 95% in the literature. 29. A rod is used to hold the vertebra together to allow fusion to occur. Better strategies need to be devised for evaluation of screw placement, including establishment of a national database of deformity surgery, use of intra-operative image guidance, and reevaluation of postoperative low-dose CT imaging. Din RS, Yan SC, Cote DJ, et al. 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. Two patients had early postoperative postural headache that disappeared after removal of the misplaced screw. 2018;83(5):9971006. Epstein NE. Of note, the award amount for one settlement case was undisclosed. 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. One hundred four of the 112 patients had a posterior procedure. MeSH 2022 Dec;31(12):3544-3550. doi: 10.1007/s00586-022-07427-0. Koktekir E, Ceylan D, Tatarli N, Karabagli H, Recber F, Akdemir G. Spine J. Segal J. 25. (A) Anteroposterior and (B) lateral radiographs taken 2 years after surgery show unilateral pseudarthrosis in a 55-year-old man with spinal stenosis. Epstein NE. Forty-seven general complications were seen in 41 patients (36.5%). Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. 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. Mayo Clinic uses the latest robot-assisted technology when indicated to enhance surgical precision in these procedures. J Neurosurg. 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. Wiltse LL, Spencer CW: New uses and refinements of the paraspinal approach to the lumbar spine. 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. Bydon M, Xu R, Amin AG, et al. Once the spine is exposed, the appropriate levels of fixation are confirmed with the image intensifier. Balch CM, Oreskovich MR, Dyrbye LN, et al. Sethi MK, Obremskey WT, Natividad H, et al. 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. Safety and efficacy of pedicle screw placement using intraoperative computed tomography: consecutive series of 1148 pedicle screws. 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.
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