Spine neurosurgeons facing the judicialization of their profession: disenchantment and alteration of daily practicea qualitative study. Cotrel Y, Dubousset J, Guillaumat M: New universal instrumentation in spinal surgery. First, this is a retrospective analysis of cases obtained from the web-based Westlaw Edge legal research database. Neurosurgery. Instead, the defense offered up an alternative explanation for Nyquists foot drop. Cases involving wrong-level or -side surgery, implant malfunction, or other misplaced spinal instrumentation (e.g., interbody cases, rods, surgical instruments, etc.) Mason A, Paulsen R, Babuska JM, et al. These numbers are in line with the current literature. Thirty-five (27.56%) had IMP and 18 (14.17%) had SAR. Spine 13:952953, 1988. Once the spine is exposed, the appropriate levels of fixation are confirmed with the image intensifier. In the remaining patients, the standard construct was three-segment fixation spanning four vertebrae and three discs, two above and one below the fractured vertebra, using six screws. Bethesda, MD 20894, Web Policies FOIA 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%). 30. 2013;123(9):20992103. 2018;28(2):186193. Among the plaintiff-awarded cases, 13 (61.9%) were decided by jury trial, 7 (33.3%) by settlement, and 1 (4.8%) by arbitration. A Cotrel-Dubousset spinal system (Medtronic Sofamor Danek, Memphis, TN) was used in all patients and the total number of screws used was 658. 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. The screws were needed to stabilize the spine and fix the fused vertebrae in place. Pitfall: Unstable injuries. [] Computer-assisted computed tomography (CT) techniques have improved the overall accuracy for pedicle screw placement, and has reduced complication rates. Examples of both laterally and medially misplaced lumbar pedicle screws are provided in Fig. Rajasekaran S, Bhushan M, Aiyer S, et al. 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. 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. Quinnell RC, Stockdale HR: Some experimental observations of the influence of a single lumbar floating fusion on the remaining lumbar spine. The intent is to provide relief from pain and nerve damage. 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. Defensive medicine in U.S. spine neurosurgery. Guzek RH, Mitchell SL, Krakow AR, Harshavardhana NS, Sarkissian EJ, Flynn JM. Rajaee SS, Bae HW, Kanim LE, Delamarter RB. Back pain/spinal stenosis and neurogenic claudication/radiculopathy were the most frequently reported indications for the index surgery, accounting for 13 (19.1%) and 11 (16.2%) cases, respectively. 2022 Jun;8(2):234-241. doi: 10.21037/jss-22-28. 1. There were two complete degenerations of the upper disc, one central canal stenosis, and two asymptomatic disc space narrowings and retrolistheses. Neurosurgical practice liability: relative risk by procedure type. Koktekir E, Ceylan D, Tatarli N, Karabagli H, Recber F, Akdemir G. Spine J. 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. J Pediatr Orthop. Personal consequences of malpractice lawsuits on American surgeons. Potential complications may include increased pain, infection, or mechanical . 22. The cost of defensive medicine on 3 hospital medicine services. 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. A total of 2396 screws were placed accurately (87.96%). You are talking one of the most complicated area of the law. 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. 2009;10(1):3339. Introduction. 1,12,19,22 The largest series of adjacent segment breakdown was reported by Schlegel et al. Spine 18:23252326, 1993. J Am Coll Surg. Most of these complications were minor and with the exception of two misplaced screws, did not contribute to the occurrence of neurologic impairment or severe pain. J Spine Surg. Nyquist had requested the defendants offer, which in retrospect was perhaps a poor decision in light of the Kane County jurys verdict. 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. Insuring spinal neurosurgery. 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. Whitecloud et al 35 reported an overall 45% rate of minor and major complications, with the rate of complications increasing to 63% in patients who had previous lumbar surgery. However, published reports are increasingly demonstrative of the positive effect of pedicle fixation on arthrodesis and successful outcome in the treatment of patients with these disorders. 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. 3. Re: malpositioned pedicle screw resulting in additional surgery and disability. 2012;41(2):6973. St Louis, CV Mosby 322327, 1987. 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. 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. It argued that the foot drop was unavoidable and due to the surgeons need to manipulate the right L5 nerve root in order to remove Nyquists herniated disc during the spinal fusion surgery. 2007;106(6):11081114. Spine 18:18621866, 1993. Cookie Policy. Weinstein JN, Spratt KF, Spengler D, Brick C, Reid S: Spinal pedicle fixation: Reliability and validity of roentgenogram-based assessment and surgical factors on successful screw placement. Wolters Kluwer Health Bydon M, Xu R, Amin AG, et al. Surg Neurol Int. When adjusted for inflation, these values increased to $1,330,201 $882,023 versus $970,832 $381,619, respectively (p = 0.32; Fig. Although the rate of the reported complications was high, the final outcome of the patients was not affected significantly. Waddell G, Kummell EG, Lotto WN, et al: Failed lumbar disc surgery and repeat surgery following industrial injuries. Reviewed submitted version of manuscript: all authors. 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. Johnston II CE, Ashman RB, Baird AM, Allard RN: Effect of spinal construct stiffness on early fusion mass incorporation: Experimental study. 2014;75(6):609613. Problems in the instrumented segments were considered those occurring from narrowing of the disc space greater than 3 mm, pseudarthrosis, and loss of reduction. Excessive hemorrhage occurred in two patients (1.8%) with coagulation disorders. 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 . Health Aff (Millwood). The remaining two patients had asymptomatic junctional problems develop after two- and three-segment fusions, at the third and fourth postoperative year, respectively. 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). Yuan HA, Garfin SR, Dickman CA, Mardjetko SM: A historical cohort study of pedicle screw fixation in thoracic, lumbar and sacral spinal fusions. Nottmeier EW, Seemer W, Young PM. 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. may email you for journal alerts and information, but is committed Adjusted for age and preoperative Cobb angle, patients with a higher misplacement rate were more likely to have screws . Pedicle screw insertion in the thoracolumbar spine. This study quantifies the rate of screw misplacement on a per-patient basis to highlight its effect on potential morbidity. West III JL, Bradford DS, Ogilvie JW: Complications of the variable screw pedicle screw fixation. 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. Neurosurgical experience with malpractice litigation: an analysis of closed claims against neurosurgeons in New York State, 1999 through 2003. Spine (Phila Pa 1976). Also notable, only one claim reported the use of intraoperative CT and was ultimately ruled in favor of the defendant. 24. Pedicle screw insertions are commonly used for posterior fixation to treat various spine disorders, deformities, and trauma. Deyo RA, Mirza SK, Martin BI. The site is secure. matte black square deadbolt; roberts point park fishing report; qr code on binax covid test; mff premium character list. Crawford MJ, Esses SI: Indications for pedicle fixation: Results of NASS/SRS faculty questionnaire: North American Spine Society and Scoliosis Research Society. Amount awarded to plaintiffs by US region, adjusted for inflation as of April 2020. Rynecki ND, Coban D, Gantz O, et al. Your message has been successfully sent to your colleague. In the current study, only five patients with junction problems above the instrumented area were observed with the following probable predisposing factors: an already degenerative disc, coronal imbalance, very long arthrodesis, and old age. Screws were divided into four categories: screws at risk (SAR), indeterminate misplacements (IMP), benign misplacements (BMP), accurately placed (AP). Luque ER: Segmental spinal instrumentation of lumbar spine. Katonis PG, Kontakis GM, Loupasis GA, et al: Treatment of unstable thoracolumbar and lumbar spine injuries using Cotrel-Dubousset instrumentation. Jury awards $4.5M over misplaced pedicle screw during spine surgery: 5 things to know Spine Monday, May 7th, 2018 Post Listen Text Size On April 6, a Union County, N.J., jury awarded a plaintiff $4.5 million over a botched spine surgery. 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. Dr. K. D. Than is a consultant for Bioventus and receives honoraria from DJO and LifeNet Health. Complications were classified as general, hardware-related, problems associated with the instrumented segments, junctional level problems, and problems related with balance (Table 2). It is an effective procedure in that it provides an almost immediate stabilization of the spine [ 2-5 ]. Segal J. Friedlander and Bradley will pay half of the $2.25 million. Would you like email updates of new search results? Spine 24:23522357, 1999. Pedicle screw fixation is an effective but demanding method to treat various spinal disorders and is associated with a significant complication rate. 3,4,9,29,34 In addition, developments in surgical technique and implant design have decreased operative risk and implant-related complications. Epstein NE. 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. Privacy Policy. Spine (Phila Pa 1976). Dr. Shaffrey has received grants from the NIH and Department of Defense. Acta Neurochir (Wien). Rothberg MB, Class J, Bishop TF, et al. Spine 15:1114, 1990. The majority of plaintiffs were male (n = 44, 64.7%), and the median age among all cases was 46 years (range 3757 years). In patients with degenerative conditions, all of the affected segments were included in the instrumentation and each vertebra was fixed with two pedicle screws. Spinal fusion in the United States: analysis of trends from 1998 to 2008. It is easier to confuse a jury than convince a judge: the crisis in medical malpractice. Elsamadicy AA, Sergesketter AR, Frakes MD, Lad SP. Din RS, Yan SC, Cote DJ, et al. In unstable injuries, the segments above and below the level of injury may have a different orientation of the pedicle trajectory due to . Ultimately, no significant differences were seen in inflation-adjusted award information between plaintiff and defendant (Table 3). A p < 0.05 was considered statistically significant. The development of the transpedicle screw has provided control of the vertebral motion segment in each plane, resisting any type of load. 2019;19(7):12211231. Descriptive analysis of state and federal spine surgery malpractice litigation in the United States. Finally, considering the problems of balance, it seems that failure to properly evaluate any preexisting scoliosis was a main cause of this important complication. J Neurosurg Spine. 2006;65(4):416421. Placement of the pedicle screws in the thoracolumbar and lumbar spine is a technically demanding procedure. Pediatric pedicle screw placement using intraoperative computed tomography and 3-dimensional image-guided navigation. The initial search using the terms above returned 3654 cases. Determining legal responsibility in otolaryngology: a review of 44 trials since 2008. The plaintiff underwent revision surgery in May 2013. This study revealed an overall accuracy rate of 95.2% of mainly percutaneously inserted pedicle screws according to the classification of Zdichavsky et al. Br J Neurosurg. Please try again soon. Statistical analysis: Sankey. Conception and design: Sankey, KD Than. What can spine surgeons do to improve patient care and avoid medical negligence suits? Illinois Jury Finds in Favor of Doctor in Gallbladder Surgery that Led to Fatal Bowel Perforation Nickl v. Barry S. Rosen, M.D. Schatlo B, Molliqaj G, Cuvinciuc V, et al. However, the defendant doctor maintained that Nyquists foot drop was not caused by the misplaced screw. These risks can be minimized by the judicious use of instrumentation by experienced surgeons for specific indications as supported by the literature. reported that 69.3% of neurosurgeons who responded to their survey saw every patient as a potential lawsuit.1. J Neurosurg Spine. 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. The average age of the patients was 47 years and the average followup was 35 months. Spine fixation included one segment in 27 patients, two segments in 38 patients, three segments in 42 patients, and more than three segments in five patients. Clin Orthop 284:8090, 1992. Nayar G, Blizzard DJ, Wang TY, et al. Accessibility Malpractice litigation following spine surgery. The standard imaging technique for pedicle screw insertion is two-dimensional images obtained from C-arm-type X-ray fluoroscopy. 2012;21(suppl 2):S196S199. Epub 2014 Jun 13. 33. Results: A total of 2724 screws were placed in 127 patients. Dr. Abd-El-Barr is a consultant for Spineology. 38. Spine J. Each case was then carefully screened for relevance and sufficient data. 2. 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. Median screw misplacement rate was 10% in group A and 13% in group B. Breakage of a divergent screw of a Chopin block at the lumbosacral area was seen 3 months after surgery. The median time to case closure was longer for defendant-awarded cases, but this finding was not statistically significant (61.5 vs 56.3 months, p > 0.05). 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). 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. However, the misplacement of pedicle screws can lead to disastrous complications. Hardware-related failures were observed in 12 patients (10.7%). Presse Med 78:14471448, 1970. Ahmadi SA, Sadat H, Scheufler KM, et al. Using Low-Dose, Biplanar Imaging to Reduce Screw Misplacement. Accuracy of fluoroscopically-assisted pedicle screw placement: analysis of 1,218 screws in 198 patients. Safety and efficacy of pedicle screw placement using intraoperative computed tomography: consecutive series of 1148 pedicle screws. 8,24,25,32. 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. Moffatt-Bruce SD, Ferdinand FD, Fann JI. This demonstrates technical ability but does not represent the impact of screw misplacement on individual patients. Whitecloud III TS, Butler JC, Cohen JL, Candelora PD: Complications with the variable spinal plating system. Patient safety: disclosure of medical errors and risk mitigation, Neurosurgical practice liability: relative risk by procedure type. Legal liability in iatrogenic orbital injury. With increasing pedicle screw usage, the number of patients with misplaced screws will likely increase proportionally. J Neurosurg. A TLIF is a surgical procedure that attempts to fuse vertebrae in order to stabilize the patient's spine. 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. A CT scan was taken to try and identify the underlying neurological problem that might be causing the new symptom. The authors of the current study aimed to describe this impact in the United States, as well as to suggest a potential method for mitigating the problem. 2018;27(9):23392347. Melissa Nyquist required a lumbar back fusion for a herniated disc at the L4-5 level. 2018;29(4):397406. 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). 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. 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. One hundred twelve consecutive patients were entered into a retrospective study of instrumented thoracolumbar, lumbar, and lumbosacral spinal arthrodesis at our institution, between September 1994 and January 1999. 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. Continued clinical experience with various pedicle screw implant systems has led to ongoing improvements in system design to minimize implant failure rates and to improve ease of system application. Except for two patients with spinal metastatic disease, all other patients received an iliac crest autologous bone grafts. 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. Spine surgery has been disproportionately impacted by medical liability and malpractice litigation, with the majority of claims and payouts related to procedural error. Daniels AH, Ruttiman R, Eltorai AEM, et al. Agarwal N, Gupta R, Agarwal P, et al. Spine 16(8 Suppl):S455458, 1991. Both of these patients complained of thigh pain but refused any additional surgery. Before Acquisition of data: Sankey. Smith TR, Hulou MM, Yan SC, et al. 2018;43(14):984990. Harris RI, Wiley JJ: Acquired spondylolysis as a sequel to spine fusion. Through the use of expert witness testimony, Mr. da Costa was able to prove to the jury that by misplacing the pedicle screw during the surgery, and failing to timely diagnose and correct the malpositioned screw, Defendants deviated from accepted standards of care. A total of 69 patients (mean age, 67.416 . 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. As part of the surgery, Dr. Taras Masnyk inserted four metal screws into the plaintiffs spine. Pedicle screw instrumentation is widely used for the stabilization of the subaxial cervical, thoracic, and lumbar spine. 14. Screws penetrating the anterior cortex and abutting vascular structures, particularly aortic abutment with left-sided screws, which can lead to erosion and pseudoaneurysms. Junctional problems were recorded as pathologic changes of the adjacent motion segments, just above and below the instrumented and fused segments. 2022 Dec;31(12):3544-3550. doi: 10.1007/s00586-022-07427-0. A total of 2396 screws were placed accurately (87.96%). J Neurosurg Spine. Steinmann JC, Herkowitz HN: Pseudarthrosis of the spine. Lali Sekhon, Jocelyn Idema & more: 4 spine and neurosurgeons making headlines, Spinal cord stimulation trumps medication for pain reduction 7 takeaways, Dr. Khalid Kurtom on major trends in spinal cord injury surgery. J Neurosurg. Scarone P, Vincenzo G, Distefano D, et al. The third patient, who had central spinal stenosis, was treated by decompression alone. The jury found the defendants liable and allocated 75 percent of the fault to Dr. Friedlander and 25 percent to Dr. Bradley. Spine 13:10121018, 1988. Overall reported screw misplacement is low, but it does not reflect the potential impact on patient morbidity. official website and that any information you provide is encrypted 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). Thu, May 27th, 2021. 2018;41(5):e615e620. Drafting the article: Sankey. 25. 2014;174(11):18671868. There were no observed cases of screw misplacement outside the pedicle on routine AP and lateral radiographs. Fortunately, most of the complications were minor and transient. 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. 34. As part of the surgery, Dr. Taras Masnyk inserted four metal screws into the plaintiff's spine. There were nine instrumentation failures at the thoracolumbar area (seven patients), lumbar area (one patient), and lumbosacral area (one patient). 2014;20(2):196203. Quraishi NA, Hammett TC, Todd DB, et al. 17,18,31,39 Edwards 6 showed that solid arthrodesis developed in 96% of patients without previous surgery, whereas 84% of patients having secondary operations experienced a similar result. 2014;96(4):266270. Long spine fixation was necessary for patients with tuberculous spondylitis and metastatic disease. Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. 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. 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. When grouped by US region, most cases occurred in the Northeast (n = 25, 36.8%), followed by the West (n = 15, 22.1%; Fig. And while the jury debated for about two hours, at the end of its deliberation it sided with the defendants and entered a not guilty verdict. 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. 19. Problems at the junctions of the instrumented spine were seen in five patients (4.5%). Intraoperative pedicle fractures requiring further points of fixation. 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.
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