Forty-seven general complications were seen in 41 patients (36.5%). Spine (Phila Pa 1976). 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 ]. J Bone Joint Surg 62A:13021307, 1980. Over 40% of patients had screws with either some/major concern. sharing sensitive information, make sure youre on a federal Pedicle screw construct have become one of the most practiced procedure in spinal surgery. The third patient, who had central spinal stenosis, was treated by decompression alone. Critically revising the article: all authors. Pedicle screw insertion in the thoracolumbar spine. Some error has occurred while processing your request. We serve the following localities: Cook County including Arlington Heights, Barrington, Berwyn Township, Chicago, Des Plaines, Glenview, Orland Park, Palos Park, Schaumburg, and Tinley Park; DuPage County including Downers Grove, Naperville, and Bolingbrook; Kane County including Aurora, Elgin and Geneva; Lake County including Waukegan; and Will County including Joliet. 1). Epub 2014 Apr 4. Clin Orthop 203:7598, 1986. Previous biomechanical and clinical studies defining junctional segment problems are lacking and consist mainly of case reports. These numbers are in line with the current literature. 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. Retrospective analysis of reasons and revision strategy for failed thoracolumbar fracture surgery by posterior approach: a series of 31 cases. To evaluate the accuracy of pedicle screw placement using a novel classification system to determine potentially significant screw misplacement. Spine 15:908912, 1990. One of the patients had a late wound infection develop that was treated by radical debridement and removal of instrumentation. J Neurosurg Spine. 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. Friedlander and Bradley will pay half of the $2.25 million. $ = US$. Lawsuit information regarding the plaintiffs age at the time of the malpractice claim, sex, postoperative complaint, indication for index surgery, defendant surgeon specialty (neurosurgery vs orthopedics), and delayed diagnosis or treatment, as well as case location by state and case year, was obtained. Several limitations should be carefully considered when interpreting our results. Incidence and costs of defensive medicine among orthopedic surgeons in the United States: a national survey study. 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. 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. 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. 2021 Nov 26;22(1):986. doi: 10.1186/s12891-021-04860-y. Pedicle screw accuracy in thoracolumbar fractures- is routine Zdeblick 38 also reported an overall arthrodesis rate of 65% in patients without instrumentation, 77% in patients with semirigid fixation, and 95% in patients with a rigid constrained screw-rod system. 4. This study quantifies the rate of screw misplacement on a per-patient basis to highlight its effect on potential morbidity. In addition, studies have shown that over 85% of malpractice claims are either dismissed or settled out of court,14 which likely results in a high degree of underreporting. 38. Mississippi Appellate Court Affirms Medical Malpractice Defense Verdict 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. There were nine instrumentation failures at the thoracolumbar area (seven patients), lumbar area (one patient), and lumbosacral area (one patient). Epub 2014 Jun 13. Spine 16(8 Suppl):S455458, 1991. 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. Saillant G: Etude anatomique des pedicules vertebraux: Application chirurgicale. Placement of thoracolumbar pedicle screws using three-dimensional image guidance: experience in a large patient cohort. demonstrated that the number of hospital discharges for spinal fusion increased 2.4 times (137%) from 174,223 to 413,171 (p < 0.001) between 1998 and 2008.32 The true frequency of malpositioned pedicle and lateral mass screws is likely underestimated in spine surgery given the fact that the majority of misplaced screws, as well as the potential complications related to them, are not reported in practice and may be clinically silent. Spine surgery has been disproportionately impacted by medical liability and malpractice litigation, with the majority of claims and payouts related to procedural error. What can spine surgeons do to improve patient care and avoid medical negligence suits? 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. In patients with degenerative conditions, all of the affected segments were included in the instrumentation and each vertebra was fixed with two pedicle screws. Comparetto, Esq., 727-328-7900, www.florida-malpractice-lawyers.com. Re: malpositioned pedicle screw resulting in additional surgery and disability. Would you like email updates of new search results? and 17.1% of the patients included had at least one screw misplaced. Of note, the award amount for one settlement case was undisclosed. Rajaee SS, Bae HW, Kanim LE, Delamarter RB. Results: Complications and Problems Related to Pedicle Screw Fixation - LWW Problems at the junctions of the instrumented spine were seen in five patients (4.5%). J Neurosurg Spine. There were two complete degenerations of the upper disc, one central canal stenosis, and two asymptomatic disc space narrowings and retrolistheses. Dr. K. D. Than is a consultant for Bioventus and receives honoraria from DJO and LifeNet Health. However, the misplacement of pedicle screws can lead to disastrous complications. 6 Spine 18:23252326, 1993. Intraoperative pedicle fractures requiring further points of fixation. Ann R Coll Surg Engl. Under the high-low agreement, Drs. 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. 5 Those authors recommend that particular care should be taken in inserting the washers without cross threading and ensuring that they are locked down tightly, with an adequate length of rod protruding beyond the screw. 2017 Mar;5(2):109-116. doi: 10.1016/j.jspd.2016.10.007. Level of evidence: 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. Spine Deform. single homes for sale in lehigh valley, pa West III JL, Bradford DS, Ogilvie JW: Complications of the variable screw pedicle screw fixation. J Neurosurg. 3. . Retrospective Computed Tomography Scan Analysis of Percutaneously Once the spine is exposed, the appropriate levels of fixation are confirmed with the image intensifier. 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. 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. 32. Patient Suffers Permanent Nerve Damage From Spinal Surgery Cerebrospinal fluid fistulas. 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. 2013;34(6):699705. Erwin WD, Dickson JH, Harrington PR: Clinical review of patients with broken Harrington rods. 35. 2013;32(1):111119. A total of 2396 screws were placed accurately (87.96%). Screw Malposition: Are There Long-term Repercussions to Malposition of Pedicle Screws? Nahed BV, Babu MA, Smith TR, Heary RF. Defensive medicine in U.S. spine neurosurgery. National Library of Medicine 30. Minimizing Pedicle Screw Pullout Risks: A Detailed Biomechan Accessibility 16,24,28 Simultaneously, the evolution of the surgical techniques has led to increased procedural safety. You may be trying to access this site from a secured browser on the server. The rate of medical complications was 8%. 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. Copyright 1944-2023 American Association of Neurological Surgeons, Copy this link, or click below to email it to a friend. Using chi square analysis, statistically significant correlation was seen between disc space narrowing and loss of postoperative correction (p < 0.01). These complications may have resulted from powerful bending movement acting on the screw at its entry point to the bone. In six patients (5.3%) with degenerative spine disease, the disc material had been removed. In their meta-analysis of nine randomized controlled trials, Li et al. States were then grouped by US region and case year by 5-year intervals. 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.
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