Spine (Phila Pa 1976). Procedural errors led to combined payouts totaling $124,943,933 in neurosurgery claims between 2003 and 2012 in a study looking at data from the Physician Insurers Association of America Data Sharing Project.10 However, our study is the first to report the direct medicolegal impact of screw misplacement on US spine surgery, with 30.9% of judgments/settlements in favor of the plaintiff, resulting in average payouts of $1,204,422 $753,832 per claim. 2. All these problems were observed only just above the upper instrumentation level and all were observed in patients older than 55 years. The screws were needed to stabilize the spine and fix the fused vertebrae in place. Rynecki ND, Coban D, Gantz O, et al. Unilateral nonunion was seen in three patients (2.7%), associated with implant failure in one of the patients. Thus, we are unable to comment on whether all misplaced screws, particularly when asymptomatic, should be revised in an effort to prevent litigation. 2021 Nov;9(6):1541-1548. doi: 10.1007/s43390-021-00377-5. + 48 696 042 504. Bethesda, MD 20894, Web Policies and 17.1% of the patients included had at least one screw misplaced. Placement of the pedicle screws in the thoracolumbar and lumbar spine is a technically demanding procedure. Din RS, Yan SC, Cote DJ, et al. Spine 17:834837, 1992. J Am Coll Surg. 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. 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. One hundred twelve patients were treated using the Cotrel-Dubousset pedicle screw fixation system for degenerative disease (57 patients), trauma (42 patients), infection (eight patients), and tumor (five patients) of the lumbar or thoracolumbar spine. 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. 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). J Bone Joint Surg 45A:11591170, 1963. 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. For more information, please refer to our Privacy Policy. However, 5-10% of those misplaced screws are cause for concern." "To rectify this, we must have access to imaging devices during the procedure. 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. Krag MH, Beynnon BD, Pope MH, et al: An internal fixator for posterior application to short segment of the thoracic, lumbar, or lumbosacral spine. 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). Hadjipavlou A, Enker P, Dupuis P, Katzman S, Silver J: The causes of failure of lumbar transpedicular spinal instrumentation and fusion: A prospective study. However, following the spinal fusion, Nyquist began to experience foot drop in her right foot. * Lumbar Spine Surgery. Spine arthrodesis was evaluated with plain AP and lateral radiographs taken 1 year after surgery. This retrospective study analyzes the complications and the problems developed during and after pedicle screw fixation in patients with spinal disorders and trauma. However, the impact of robotic-assisted spinal fusion on patient outcomes is less clear. Level of evidence: 7. What can spine surgeons do to improve patient care and avoid medical negligence suits? Erwin WD, Dickson JH, Harrington PR: Clinical review of patients with broken Harrington rods. Please enable scripts and reload this page. 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. 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. Quraishi NA, Hammett TC, Todd DB, et al. Another possible cause was the high lateral torques to the entire frame that occurred during tightening of the tulip screw. All Rights Reserved. Misplaced pedicle and lateral mass screws result in a considerable risk of malpractice litigation against spine surgeons. Spine 19:25842589, 1994. 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 . 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. The amount awarded was not significantly different across US regions (p = 0.9; Fig. The jury found the defendants liable and allocated 75 percent of the fault to Dr. Friedlander and 25 percent to Dr. Bradley. Spine 18:18621866, 1993. NCI CPTC Antibody Characterization Program. 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. 14. 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. 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. 4. 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. Instead, the defense offered up an alternative explanation for Nyquists foot drop. Incidence and costs of defensive medicine among orthopedic surgeons in the United States: a national survey study. Debate Over Extent of Eye Damage Following Implant Lens Surgery Leads to $1 Million Verdict in Zaleski v Elmhurst Eye Surgery Center. 26. Results: Placement of thoracolumbar pedicle screws using three-dimensional image guidance: experience in a large patient cohort. Quinnell RC, Stockdale HR: Some experimental observations of the influence of a single lumbar floating fusion on the remaining lumbar spine. The .gov means its official. 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. Sarwahi V, Ayan S, Amaral T, Wendolowski S, Gecelter R, Lo Y, Thornhill B. Spine Deform. Misplacement rates have been reported to be from 5 to 41% in the lumbar spine and from 3 to 55% in the . Spine neurosurgeons facing the judicialization of their profession: disenchantment and alteration of daily practicea qualitative study. The most frequent primary injury listed for a lawsuit was nerve root injury, present in 81.0% (n = 17) and 74.5% (n = 35) of plaintiff- and defendant-awarded cases, respectively (p = 0.7). 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? Both of these patients complained of thigh pain but refused any additional surgery. A retrospective review of closed medicolegal cases with verdicts or settlements between 1995 and 2019 was performed using the Westlaw Edge legal research database (Thomson Reuters).7,14,16,23,24 A search of closed federal and state malpractice claims within the Verdicts and Settlements section consisted of the following: spine and surgery and pedicle and screw and fusion and (misplaced or misguided or mispositioned) and surgeon. Inclusion criteria consisted of malpractice claims against surgeons for complications related to misplaced pedicle and/or lateral mass screws. 2012;7(6):e39237. 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. Agarwal N, Gupta R, Agarwal P, et al. There were nine instrumentation failures at the thoracolumbar area (seven patients), lumbar area (one patient), and lumbosacral area (one patient). Waddell G, Kummell EG, Lotto WN, et al: Failed lumbar disc surgery and repeat surgery following industrial injuries. The total number of reoperations for MPS and patient clinical data were obtained from medical records at each hospital. 38. 17. 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. Two patients had an acute infection develop for which they required operative intervention with irrigation and debridement. Cookie Policy. 2006;65(4):416421. 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. Some error has occurred while processing your request. Materials and Methods Sixty . 2. Epstein NE. These risks can be minimized by the judicious use of instrumentation by experienced surgeons for specific indications as supported by the literature. Two patients had early postoperative postural headache that disappeared after removal of the misplaced screw. Objective: Personal consequences of malpractice lawsuits on American surgeons. (%), Pseudarthrosis requiring revision surgery. Plaintiff-awarded cases by US region (left). Patient safety: disclosure of medical errors and risk mitigation. JAMA. 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. Whitecloud III TS, Butler JC, Cohen JL, Candelora PD: Complications with the variable spinal plating system. 3). George Sapkas, MD, DSc; and Panayiotis J. Papagelopoulis, MD, DScGuest Editors. The link was not copied. The plaintiff underwent revision surgery in May 2013. Despite these failures, solid spinal arthrodesis was obtained in all patients. Accuracy and workflow of navigated spinal instrumentation with the mobile AIRO CT scanner. Methods. Forty-seven intraoperative and medical complications were observed in 41 patients (36.6%). Rothberg MB, Class J, Bishop TF, et al. 34. The remaining two patients had asymptomatic junctional problems develop after two- and three-segment fusions, at the third and fourth postoperative year, respectively. The contact form sends information by non-encrypted email, which is not secure. 36. J Neurosurg Spine. Accuracy of C2 pedicle screw placement using the anatomic freehand technique. 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. Koktekir E, Ceylan D, Tatarli N, Karabagli H, Recber F, Akdemir G. Spine J. Risk factor analysis showed smaller Cobb angles increased likelihood of all screws being AP. 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. Among the plaintiff-awarded cases, 13 (61.9%) were decided by jury trial, 7 (33.3%) by settlement, and 1 (4.8%) by arbitration. Edwards CC: Spinal screw fixation of the lumbar and sacral spine: Early results treating the first 50 cases. Dr. Karikari is a consultant for NuVasive, Globus, Johnson & Johnson, and DePuy and receives a spine fellowship fund from NuVasive. The rod is held in place by "pedicle screws," which the surgeon must insert into the pedicles. 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. Drs. 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. The initial search using the terms above returned 3654 cases. Malpractice litigation following spine surgery. Zucherman J, Hsu K, Picetti III G, et al: Clinical efficacy of spinal instrumentation in lumbar degenerative disc disease. Cook County Surgeons Cut Common BIle Duct During Surgery, But Jury Finds for Defendants Irwin v. Alan Loren, M.D. Safety and efficacy of pedicle screw placement using intraoperative computed tomography: consecutive series of 1148 pedicle screws. Surg Neurol Int. Harris RI, Wiley JJ: Acquired spondylolysis as a sequel to spine fusion. To prevent general complications, it is evident that precise and careful soft tissue handling, proper irrigation, and debridement during and after surgery, decrease of operative time, and proper patient monitoring postoperatively must be done. Rev Chir Orthop Reparatrice Appar Mot 62:151160, 1976. Spine surgery has been disproportionately impacted by medical liability and malpractice litigation, with the majority of claims and payouts related to procedural error. The states with the most cases included California (n = 10, 14.7%), New York (n = 6, 8.8%), Pennsylvania (n = 6, 8.8%), and Illinois (n = 5, 7.3%; Table 2). 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. Call me tomorrow. 29. 2. Fortunately, most of the complications were minor and transient. 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. 19. The rate of misplaced pedicle screws ranges from 1.1% to 28.8%, 10 although neurologic injury from misdirected pedicle screws has been reported to occur in 0% to 12% of patients. 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). Retrospective analysis of reasons and revision strategy for failed thoracolumbar fracture surgery by posterior approach: a series of 31 cases. Plaintiff's expert was prepared to testify at trial that these complaints are characteristic of a malpositioned screw impinging upon a neural structure. The development of the transpedicle screw has provided control of the vertebral motion segment in each plane, resisting any type of load. Phone/Fax: 30-2810-318361; E-mail: [emailprotected]. Dr. K. D. Than is a consultant for Bioventus and receives honoraria from DJO and LifeNet Health. 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. The patient had subsequent coronal imbalance and degeneration of the upper disc. sharing sensitive information, make sure youre on a federal JAMA. to maintaining your privacy and will not share your personal information without 2018;27(9):23392347. Cerebrospinal fluid fistulas. You are talking one of the most complicated area of the law. 2. Copyright 1944-2023 American Association of Neurological Surgeons, Copy this link, or click below to email it to a friend. N Engl J Med. 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 Dr. Abd-El-Barr is a consultant for Spineology. Neurologic injury. The highly litigious environment within healthcare has resulted in a majority of physicians practicing defensive medicine,15 often leading to burnout6,7 and an exorbitant ethical and financial burden on medical and surgical care.7,8 In 2008, medical liability accounted for $55.6 billion, representing 2.4% of the United States (US) healthcare expenditures that year,5,7,9,10 and the pervasive practice of defensive medicine may cost up to $210 billion annually in the US.5 A similar trend has been observed in Europe.11, Neurosurgery is the specialty most frequently affected by lawsuits and the fear of litigation, both in the US and abroad,12 with spine surgery at the forefront.11,1317 As a result, spine surgeons are nearly three times more likely than nonspine surgeons to practice defensive medicine, defined as the avoidance of high-risk procedures and the provision of unnecessary services and assessments beyond what is clinically necessary in an effort to avoid litagation.5 The average time to judgment in a case is approximately 5.1, 5.0, and 3.4 years for defendant verdicts, plaintiff rulings, and settlements, respectively.7,15 As a result, physicians spend an average of 11% of their careers dealing with one or more open malpractice claims.18 Neurosurgeons are especially impacted, spending an average of 27.2% of their careers in an open lawsuit.10. Of note, the award amount for one settlement case was undisclosed. 2014 Sep;21(3):320-8. doi: 10.3171/2014.5.SPINE13567. A total of 247 screws (9.07%) were BMP, 52 (1.91%) were IMP, and 29 (1.06%) were considered SAR. Clin Orthop 284:8090, 1992. 2005;293(21):26092617. 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. Daniels AH, Ruttiman R, Eltorai AEM, et al. Todd NV. 3. 24. A.J. Potential complications may include increased pain, infection, or mechanical . It is easier to confuse a jury than convince a judge: the crisis in medical malpractice. The cost of defensive medicine on 3 hospital medicine services, Defensive medicine in neurosurgery: the Canadian experience, Review of neurosurgery medical professional liability claims in the United States, A nine-year review of medicolegal claims in neurosurgery, Malpractice risk according to physician specialty, Neurosurgical experience with malpractice litigation: an analysis of closed claims against neurosurgeons in New York State, 1999 through 2003, Descriptive analysis of state and federal spine surgery malpractice litigation in the United States, Malpractice litigation following spine surgery, Medical malpractice in orthopedic surgery: a Westlaw-based demographic analysis, Malpractice claims in spine surgery in Germany: a 5-year analysis, On average, physicians spend nearly 11 percent of their 40-year careers with an open, unresolved malpractice claim, Malpractice litigation and the spine: the NHS perspective on 235 successful claims in England, Placement of thoracolumbar pedicle screws using three-dimensional image guidance: experience in a large patient cohort, It is easier to confuse a jury than convince a judge: the crisis in medical malpractice, Determining legal responsibility in otolaryngology: a review of 44 trials since 2008, Legal liability in iatrogenic orbital injury, Spine neurosurgeons facing the judicialization of their profession: disenchantment and alteration of daily practicea qualitative study, Malpractice issues in neurological surgery. Copyright © 2023 Becker's Healthcare. Pedicle screw insertion in the thoracolumbar spine. Spine J. Results: A total of 2724 screws were placed in 127 patients. Please do not include any confidential or sensitive information in a contact form, text message, or voicemail. government site. They both had motor deficits from which 1 patient recovered completely. 1. 21. Svider PF, Kovalerchik O, Mauro AC, et al. Therefore, when instrumentation is to be used, the benefits must outweigh the risks. Long spine fixation was necessary for patients with tuberculous spondylitis and metastatic disease. In two patients in the current series, dislodgement of the rods from tulip screws occurred, as reported originally by Edmunds et al. 2018;29(4):397406. J Spine Surg. All the operations were done by one surgeon (PK). 2022 Sep 15;14(9):6323-6331. eCollection 2022. Harrington PR, Tullos HS: Reduction of severe spondylolisthesis in children. 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. Median screw misplacement rate was 10% in group A and 13% in group B. 8. Spine 15:1114, 1990. 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. 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. A total of 2724 screws were placed in 127 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. Br J Neurosurg. Spine 6:615619, 1981. 2018;18(2):209215. Your message has been successfully sent to your colleague. 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. 2014;96(4):266270. Axial lumbar CT scans demonstrating both laterally (right) and medially (left) misplaced pedicle screws, resulting in pedicle and transverse process fractures (A) and canal compromise (A and B). 3. Friedlander and Bradley will pay half of the $2.25 million. Schlegel JD, Smith JA, Schleusener RN: Lumbar motion segment pathology adjacent to thoracolumbar, lumbar, and lumbosacral fusions. 2014;174(11):18671868. Junctional problems were recorded as pathologic changes of the adjacent motion segments, just above and below the instrumented and fused segments. Statistical analysis: Sankey. Your current browser may not support copying via this button. 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. Gertzbein SD, Robbins SE: Accuracy of pedicular screw placement in vivo. ObjectThe goal of this study was to determine the incidence of screw misplacement and complications in a group of 102 patients who underwent transpedicle screw fixation in the lumbosacral spine with conventional open technique and intraoperative. Achieving proper lumbar lordosis, evaluating any preexisting scoliosis, and intraoperative assessment with AP radiographs could prevent balance problems. The rate of misplaced pedicle screws ranges from 1.1% to 28.8%, 10 although neurologic injury from misdirected pedicle screws has been reported to occur in 0% to 12% of patients. 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). Pedicle screws have been used to treat spinal disorders, including those caused by spinal cancer, congenital anomalies, trauma, and chronic pain syndromes. Medical malpractice in orthopedic surgery: a Westlaw-based demographic analysis. Dr. Shaffrey has received grants from the NIH and Department of Defense. Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. Seabury SA, Chandra A, Lakdawalla DN, Jena AB. 23. Spinal fusion in the United States: analysis of trends from 1998 to 2008. 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 Bone Joint Surg 62A:13021307, 1980. Pitfall: Unstable injuries. Abstract BACKGROUND CONTEXT Surgeons have increasingly adopted robotic-assisted lumbar spinal fusion due to indications that robotic-assisted surgery can reduce pedicle screw misplacement. Of note, the award amount for one settlement case was undisclosed. Neurosurgery. your express consent. Eur Spine J. Five patients had uneventful early postoperative course. 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. We attribute the 24.1% disc space narrowing in the instrumented segments mainly to the severe injury of the disc and communication of the end plate in burst fractures, which could accelerate the disc degeneration and narrowing. Spine 14:472476, 1989. Screw misplacement. pedicle screw: A rigid surgical implant used to stabilize adjacent spinal segments in spinal fusion surgery. 11. After the removal of duplicates, a total of 68 unique cases met our inclusion criteria and were included for analysis. The screws were needed to stabilize the spine and fix the fused vertebrae in place. Malpractice risk according to physician specialty. 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. 2011;213(5):657667. Smith TR, Hulou MM, Yan SC, et al. Sethi MK, Obremskey WT, Natividad H, et al. The average age of the patients was 47 years and the average followup was 35 months. 2013;123(9):20992103. 2022 Jun;8(2):234-241. doi: 10.21037/jss-22-28. Would you like email updates of new search results? On average, physicians spend nearly 11 percent of their 40-year careers with an open, unresolved malpractice claim. Mean amounts awarded SD to plaintiffs by jury trial (n = 13) versus settlement/arbitration (n = 7), adjusted for inflation as of April 2020. Illinois Jury Finds in Favor of Doctor in Gallbladder Surgery that Led to Fatal Bowel Perforation Nickl v. Barry S. Rosen, M.D. This occurred on only one side and the correction achieved by the instrumentation was maintained. Intraoperative and postoperative complications were recorded by the authors and the results were evaluated by an independent observer. Three-dimensional printing versus freehand surgical techniques in the surgical management of adolescent idiopathic spinal deformity. 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. 3. Lorenz M, Zindrick M, Schwaegler P, et al: A comparison of single level fusion with and without hardware. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. 20. National Library of Medicine Drafting the article: Sankey. Schatlo B, Molliqaj G, Cuvinciuc V, et al. Pedicle screw placement accuracy using ultra-low radiation imaging with image enhancement versus conventional fluoroscopy in minimally invasive transforaminal lumbar interbody fusion: an internally randomized controlled trial. Methods: It should be used by experienced and qualified surgeons who are familiar with the pitfalls associated with its use. Pedicle screw instrumentation is widely used for the stabilization of the subaxial cervical, thoracic, and lumbar spine. 28. Reprint requests to Pavlos Katonis, MD, 99 Minoos & Thenon Street, 71305, Heraklion, Crete, Greece. Please try again soon. These numbers are in line with the current literature. Pedicle screw insertions are commonly used for posterior fixation to treat various spine disorders. Accessibility 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. Hecht N, Kamphuis M, Czabanka M, et al. 6. Image intensification and the technique recommended by Weinstein et al 32 was used for screw placement in the lumbar vertebrae, whereas Chopin blocks (Medtronic Sofamor Danek) with two screws diverging bilaterally were used for sacral fixation.
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