Rajasekaran S, Bhushan M, Aiyer S, et al. Placement of the pedicle screws in the thoracolumbar and lumbar spine is a technically demanding procedure. 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. Dr. K. D. Than is a consultant for Bioventus and receives honoraria from DJO and LifeNet Health. 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. Safety and efficacy of pedicle screw placement using intraoperative computed tomography: consecutive series of 1148 pedicle screws. Acta Neurochir (Wien). 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. Risk Factors for the Drift Phenomenon in Oarm NavigationAssisted Spine (Phila Pa 1976). Rev Chir Orthop Reparatrice Appar Mot 62:151160, 1976. 2014;174(11):18671868. 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. doi: 10.1097/BPO.0000000000001828. laterally placed screws and the azygous vein on the right (T5-T11). Neurological outcome and management of pedicle screws - PubMed 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. 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. 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. Accuracy of C2 pedicle screw placement using the anatomic freehand technique. Dalenberg DD, Asher MA, Robinson RG, Jayaraman G: The effect of a stiff spinal implant and its loosening on bone mineral content in canines. Screw misplacement. 19. It should be used by experienced and qualified surgeons who are aware of the pitfalls associated with its use. Cookie Policy. 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. As part of the surgery, Dr. Taras Masnyk inserted four metal screws into the plaintiff's spine. J Neurosurg Spine. George Sapkas, MD, DSc; and Panayiotis J. Papagelopoulis, MD, DScGuest Editors. Data is temporarily unavailable. 2018;27(9):23392347. West III JL, Bradford DS, Ogilvie JW: Results of spinal arthrodesis with pedicle screw-plate fixation. Quraishi NA, Hammett TC, Todd DB, et al. 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%). In our opinion, these problems may be prevented by applying the following principles: limitation of spine arthrodesis to the pathologic levels, inclusion of already extensive changes at the level above or below the planned arthrodesis into the arthrodesis, restoration of postoperative sagittal and coronal alignment, and avoidance of impingement syndrome from the adjacent nonfused facets. Elizabeth Hofheinz, M.P.H., M.Ed. Rothberg MB, Class J, Bishop TF, et al. 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). 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. Please enable scripts and reload this page. 8. 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. Clin Orthop 203:717, 1986. Clin Orthop 203:7598, 1986. 2018;18(2):209215. Each side was judged separately. The link was not copied. Pedicle screw replacement in spinal surgery - The MDU 2022 Sep 15;14(9):6323-6331. eCollection 2022. Delayed open treatment of aortic penetration by a thoracic pedicle At the lumbosacral area, breakage of a divergent screw of a Chopin block occurred on only one side with no loss of correction. Pedicle screw instrumentation is widely used for the stabilization of the subaxial cervical, thoracic, and lumbar spine. Spine 16:576579, 1991. Of note, the award amount for one settlement case was undisclosed. Melissa Nyquist required a lumbar back fusion for a herniated disc at the L4-5 level. Spine (Phila Pa 1976). Call Us Now For a Free Consultation | Toll Free: 800.583.8002 | Local: 312.346.0045, Cook County Surgeons Cut Common BIle Duct During Surgery, But Jury Finds for Defendants , Illinois Jury Finds in Favor of Doctor in Gallbladder Surgery that Led to Fatal Bowel Perforation , Debate Over Extent of Eye Damage Following Implant Lens Surgery Leads to $1 Million Verdict in, $75 Million Jury Verdict in Failure to Timely Diagnose Stroke, $18 Million Jury Verdict in Late Diagnosis of Breast Cancer, $300,000 Settlement for Excessive Use of Radiation, Chicago Medical Malpractice Lawyer Kreisman Law Offices Home, Contact Illinois Personal Injury Attorney Kreisman Law Offices. Twenty-one patients (18.8%) had thoracolumbar injuries, and loss of immediate postoperative deformity correction ranged from 1.4 to 4.5. Thirty-five (27.56%) had IMP and 18 (14.17%) had SAR. A review of medicolegal malpractice suits involving cervical spine: what can we learn or change? Pedicle screw fixation is commonly used in spinal instrumentation surgeries to connect rods to vertebrae in order to correct spine alignment, stabilize vertebrae, and reach an arthrodesis. 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. 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. Five patients had uneventful early postoperative course. Cases involving wrong-level or -side surgery, implant malfunction, or other misplaced spinal instrumentation (e.g., interbody cases, rods, surgical instruments, etc.) Unfortunately, the plaintiffs attorney was unable to offer an alternative theory of surgical negligence that would refute the defendants explanation. 2011;24(1):1519. 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. 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. In addition, the median time to judgment is substantial, particularly for defendant verdicts, spanning over 4.5 years from the time of surgery. Using Low-Dose, Biplanar Imaging to Reduce Screw Misplacement. pedicle screw misplacement malpractice Are We Underestimating the Significance of Pedicle Screw Misplacement Two patients had early postoperative postural headache that disappeared after removal of the misplaced screw. Ahmadi SA, Sadat H, Scheufler KM, et al. The cost of defensive medicine on 3 hospital medicine services. Svider PF, Kovalerchik O, Mauro AC, et al. Screws were divided into four categories: screws at risk (SAR), indeterminate misplacements (IMP), benign misplacements (BMP), accurately placed (AP). Minimizing Pedicle Screw Pullout Risks: A Detailed Biomechan Cerebrospinal fluid fistulas. Aigner R, Bichlmaier C, Oberkircher L, Knauf T, Knig A, Lechler P, Ruchholtz S, Frink M. BMC Musculoskelet Disord. Svider PF, Husain Q, Kovalerchik O, et al. 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. 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. A review of medicolegal malpractice suits involving cervical spine: what can we learn or change? The average followup was 35 months (range, 1851 months). Taylor CL. 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. In two patients in the current series, dislodgement of the rods from tulip screws occurred, as reported originally by Edmunds et al. Thoracic pedicle screw placement: Free-hand technique - Bioline The medicolegal landscape of spine surgery: how do surgeons fare? 15. Before 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. Linking and Reprinting Policy. 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. All the operations were done by one surgeon (PK). Dr. Shaffrey has received grants from the NIH and Department of Defense. Katonis PG, Kontakis GM, Loupasis GA, et al: Treatment of unstable thoracolumbar and lumbar spine injuries using Cotrel-Dubousset instrumentation. Neurologic injury. Spine 14:472476, 1989. 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. Ultimately, no significant differences were seen in inflation-adjusted award information between plaintiff and defendant (Table 3). Guzek RH, Mitchell SL, Krakow AR, Harshavardhana NS, Sarkissian EJ, Flynn JM. J Bone Joint Surg 54A:11951204, 1972. 2006;65(4):416421. There were no observed cases of screw misplacement outside the pedicle on routine AP and lateral radiographs. 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. J Pediatr Orthop. The site is secure. 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. 13 Whitecloud et al 35 reported 15% neurologic complications, 5% being caused by incorrect screw placement. What can spine surgeons do to improve patient care and avoid medical negligence suits? Comparison of pedicle screw placement accuracy between two types of This retrospective study analyzes the complications and the problems developed during and after pedicle screw fixation in patients with spinal disorders and trauma. Under the high-low agreement, Drs. Mukherjee S, Pringle C, Crocker M. A nine-year review of medicolegal claims in neurosurgery. Robotic-assisted pedicle screw placement fails to reduce overall 2020;162(6):13791387. INCLUDE WHEN CITING DOI: 10.3171/2020.8.FOCUS20600. Saillant G: Etude anatomique des pedicules vertebraux: Application chirurgicale. Epub 2021 Aug 28. Plaintiff-awarded cases by US region (left). 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. Copyright © 2023 Becker's Healthcare. 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. However, following the spinal fusion, Nyquist began to experience foot drop in her right foot. Edmunds I, Cummine J, Fearnside M: Prevention of dislodgement of Cotrel-Dubousset rods from tulip screws. With increasing pedicle screw usage, the number of patients with misplaced screws will likely increase proportionally. 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. The third patient, who had central spinal stenosis, was treated by decompression alone. 4. $ = US$; MW = Midwest; NE = Northeast; SE = Southeast; SW = Southwest; W = West. 2013;123(9):20992103. Objective: Jena AB, Seabury S, Lakdawalla D, Chandra A. Eur Spine J. Retrospective Computed Tomography Scan Analysis of Percutaneously Spine J. Spine J. 5. Spine (Phila Pa 1976). There were two complete degenerations of the upper disc, one central canal stenosis, and two asymptomatic disc space narrowings and retrolistheses. 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. In White AH, Rothman RH, Ray CD (eds). Reviewed submitted version of manuscript: all authors. Pedicle Screw Insertion in Spondylitis Tuberculosis | ORR 2020;11:38. 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. haroinfather roblox id J Am Coll Surg. Thus, we are unable to comment on whether all misplaced screws, particularly when asymptomatic, should be revised in an effort to prevent litigation. Arthrodesis was questionable in eight asymptomatic patients (7.1%). 2021 Jul 1;41(Suppl 1):S80-S86. Amount awarded to plaintiffs by US region, adjusted for inflation as of April 2020. Unauthorized use of these marks is strictly prohibited. Results: 2014;20(6):636643. Bookshelf Spine 6:615619, 1981. These complications may have resulted from powerful bending movement acting on the screw at its entry point to the bone. CT-navigation versus fluoroscopy-guided placement of pedicle screws at A CT scan was taken to try and identify the underlying neurological problem that might be causing the new symptom. 8,24,25,32. In their meta-analysis of nine randomized controlled trials, Li et al. 29. Li HM, Zhang RJ, Shen CL. It was firstly introduced by Harrington and Tullos in 1969 and then in late 1980s developed by Roy Camille et al., Louis, and Steffe. Pedicle screw insertions are commonly used for posterior fixation to treat various spine disorders. As part of the surgery, Dr. Taras Masnyk inserted four metal screws into the plaintiffs spine. A total of 2724 screws were placed in 127 patients. Mason A, Paulsen R, Babuska JM, et al. In situ spine arthrodesis permits load sharing by the vertebral bodies, preventing fatigue failure of the implant. Morphometric analysis of the proximal thoracic pedicles in Lenke II and IV adolescent idiopathic scoliosis: an evaluation of the feasibility for pedicle screw insertion. J Spinal Disord Tech. Conversely, Nyquists foot drop did not resolve after the screw was removed, which begged the question of whether the foot drop was in fact caused by the misplaced screw. The patient had to undergo a subsequent surgery to remove the pedicles. Whitecloud III TS, Butler JC, Cohen JL, Candelora PD: Complications with the variable spinal plating system. Lorenz M, Zindrick M, Schwaegler P, et al: A comparison of single level fusion with and without hardware. Crawford MJ, Esses SI: Indications for pedicle fixation: Results of NASS/SRS faculty questionnaire: North American Spine Society and Scoliosis Research Society. 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. Accuracy of fluoroscopically-assisted pedicle screw placement: analysis of 1,218 screws in 198 patients. Neurosurgery. 2022 Dec;31(12):3544-3550. doi: 10.1007/s00586-022-07427-0. Preparation. government site. were excluded from analysis. 2016;25(3):716723. 30. Subjects were 10,754 patients (73,777 pedicle screws) who underwent PSF at 11 hospitals over 15 years. Background The objective of this cadaveric study was to analyze the effects of iatrogenic pedicle perforations from screw misplacement on the mean pullout strength of lower thoracic and lumbar pedicle screws. 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. 2021 Nov 26;22(1):986. doi: 10.1186/s12891-021-04860-y. JAMA. Hardware problems were those related to the physical change of metal and screw position. Despite this problem, the clinical result was excellent. A TLIF is a surgical procedure that attempts to fuse vertebrae in order to stabilize the patient's spine. Spine 18:18621866, 1993. The third surgical procedure removed the pedicle screws but left the patient in an unfused state with an unstable spine. Reoperation for Misplaced Pedicle Screws: A Multicenter Retrospec 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. Screws penetrating the anterior cortex and abutting vascular structures, particularly aortic abutment with left-sided screws, which can lead to erosion and pseudoaneurysms. Forty-seven intraoperative and medical complications were observed in 41 patients (36.6%). Per-patient analysis showed 23 (18.11%) of patients had all screws AP. None of these complications resulted in additional surgery or in a significant increase of morbidity. Spine surgery has been disproportionately impacted by medical liability and malpractice litigation, with the majority of claims and payouts related to procedural error. General complications were considered those developing during and after surgery that were not directly related to instrumentation. 2. To evaluate the accuracy of pedicle screw placement using a novel classification system to determine potentially significant screw misplacement. Louw JA, Dommissee GF, Roos MF: Spinal stenosis following anterior spinal fusion. Autor de la entrada Por ; Fecha de la entrada austin brown musician; matrix toners for bleached hair . Achieving proper lumbar lordosis, evaluating any preexisting scoliosis, and intraoperative assessment with AP radiographs could prevent balance problems. Spine surgery has been disproportionately impacted by medical liability and malpractice litigation, with the majority of claims and payouts related to procedural error. Acquisition of data: Sankey. Guillain A, Moncany AH, Hamel O, et al. Pedicle screw fixation is an effective but demanding method to treat various spinal disorders and is associated with a significant complication rate. Excessive hemorrhage occurred in two patients (1.8%) with coagulation disorders. 39. 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. 33. A retrospective review of charts, x-rays (XRs) and computed tomography (CT) scans was performed. Moffatt-Bruce SD, Ferdinand FD, Fann JI. Start; O firmie; Usugi; Serwis; Realizacje i porady; Kontakt Pediatric pedicle screw placement using intraoperative computed tomography and 3-dimensional image-guided navigation. Summary of background data: Zucherman J, Hsu K, Picetti III G, et al: Clinical efficacy of spinal instrumentation in lumbar degenerative disc disease. Surg Neurol. Misplacement of Pedicle Screws Leads to Years of Pain and Opioid Addiction Nationally Recognized Regionally Dominant Contact Us Now For a Free Consultation Over $850 Million in Verdicts and Settlements Home Articles Misplacement of Pedicle Screws Leads to Years of Pain and Opioid Addiction Error in trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. We avoid using sharp automated drilling, and probe fully the pedicle cavity to prevent nerve root impairment. It is easier to confuse a jury than convince a judge: the crisis in medical malpractice. Results. Recently, robot-assisted pedicle screw implantation has been increasingly utilized at large-volume academic centers. Zdeblick TA: A prospective randomized study of lumbar fusion: Preliminary results. Pullout performance comparison of pedicle screws based on cement application and design parameters Tolga Tolunay, Cemile Bagl, Teyfik Demir, Mesut E Yaman, and Arslan K Arslan Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 2015 229: 11 , 786-793 Download Citation Neurosurgeons and orthopedic surgeons were named as the defendant in an equal number of cases, and the decision for the plaintiff versus the defendant was also similar between specialties. The screws were needed to stabilize the spine and fix the fused vertebrae in place. Friedlander and Bradley will pay half of the $2.25 million. HHS Vulnerability Disclosure, Help 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). J Bone Joint Surg 73A:11791184, 1991. PURPOSE This study aimed to compare rates of perioperative complications between robotic-assisted and conventional . 2022 Jun;8(2):234-241. doi: 10.21037/jss-22-28. Screws were divided into four categories: screws at risk (SAR), indeterminate misplacements (IMP), benign misplacements (BMP), accurately placed (AP). Epstein NE. your express consent. 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). 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). Neurosurgical experience with malpractice litigation: an analysis of closed claims against neurosurgeons in New York State, 1999 through 2003. The contact form sends information by non-encrypted email, which is not secure. 14. Neurological Outcome and Management of Pedicle Screws Misplaced Totally 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). 1. Nayar G, Blizzard DJ, Wang TY, et al. Inaccurate pedicle screw placement is relatively common even when placement is performed under fluoroscopic control. Although the rate of the reported complications was high, the final outcome of the patients was not affected significantly. 24. Per-patient analysis reveals more concerning numbers toward screw misplacement. Please try again soon. The last two patients had a T12L1 fracture-dislocation and a L4L5 spondylolytic spondylolisthesis at the site of plug dislodgments. Spine 18:23252326, 1993. Hecht N, Kamphuis M, Czabanka M, et al. A total of 2396 screws were placed accurately (87.96%). Pullout performance comparison of pedicle screws based on cement On April 6, a Union County, N.J., jury awarded a plaintiff $4.5 million over a botched spine surgery. Steinmann JC, Herkowitz HN: Pseudarthrosis of the spine. Analysis and interpretation of data: Sankey, TT Than. 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. Am J Transl Res. Also notable, only one claim reported the use of intraoperative CT and was ultimately ruled in favor of the defendant. 2012;21(suppl 2):S196S199. 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). 1. 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. Malpractice claims in spine surgery in Germany: a 5-year analysis. A.J. 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. Ann R Coll Surg Engl.
