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J Am Coll Surg. The screws were needed to stabilize the spine and fix the fused vertebrae in place. Unfortunately, the plaintiffs attorney was unable to offer an alternative theory of surgical negligence that would refute the defendants explanation. 28. Dr. K. D. Than is a consultant for Bioventus and receives honoraria from DJO and LifeNet Health. 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. Ann R Coll Surg Engl. Wiltse LL, Spencer CW: New uses and refinements of the paraspinal approach to the lumbar spine. Nahed BV, Babu MA, Smith TR, Heary RF. Neurosurgical experience with malpractice litigation: an analysis of closed claims against neurosurgeons in New York State, 1999 through 2003. 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. Pedicle screw insertions are commonly used for posterior fixation to treat various spine disorders, deformities, and trauma. . Sarwahi V, Ayan S, Amaral T, Wendolowski S, Gecelter R, Lo Y, Thornhill B. Spine Deform. Accuracy of pedicle screw placement and clinical outcomes of robot-assisted technique versus conventional freehand technique in spine surgery from nine randomized controlled trials: a meta-analysis. Twenty-one patients (18.8%) had thoracolumbar injuries, and loss of immediate postoperative deformity correction ranged from 1.4 to 4.5. 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. Ultimately, additional prospective, multiinstitutional large-volume studies are needed to validate these findings, and future studies should evaluate the long-term impact on the routine use of intraoperative imaging confirmation and/or computer- or robot-assisted navigation on the frequency and success of malpractice claims related to misplaced pedicle and lateral mass screws. 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. 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). Using chi square analysis, statistically significant correlation was seen between disc space narrowing and loss of postoperative correction (p < 0.01). As part of the surgery, Dr. Taras Masnyk inserted four metal screws into the plaintiffs spine. may email you for journal alerts and information, but is committed Friedlander and Bradley will pay half of the $2.25 million. However, we did not observe any screw breakage in patients with a degenerative lumbar spine, and the absence of broken screws in this series is because arthrodesis in almost all patients occurred in situ. Placement of the pedicle screws in the thoracolumbar and lumbar spine is a technically demanding procedure. 8,24,25,32. Thu, May 27th, 2021. The last two patients had a T12L1 fracture-dislocation and a L4L5 spondylolytic spondylolisthesis at the site of plug dislodgments. 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. 25. 1 Although this technique has advantages over open instrumentation, it also presents new challenges and specific complications. Spine (Phila Pa 1976). Katonis, Pavlos MD*; Christoforakis, Joseph MD*; Aligizakis, Agisilaos C. MD*; Papadopoulos, Charalampos MD*; Sapkas, George MD, DSc**; Hadjipavlou, Alexander MD*. Median screw misplacement rate was 10% in group A and 13% in group B. 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. Phone/Fax: 30-2810-318361; E-mail: [emailprotected]. Each side was judged separately. 2013;34(6):699705. 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. L3S1 spine arthrodesis was done in the first patient but the correction of scoliosis was not sufficient and coronal imbalance persisted after surgery, which accelerated the degeneration of the level just above the arthrodesis. 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. Harris RI, Wiley JJ: Acquired spondylolysis as a sequel to spine fusion. 2021 Jul 1;41(Suppl 1):S80-S86. The link was not copied. J Neurosurg Spine. Spine 17:349355, 1992. J Bone Joint Surg 54A:11951204, 1972. Li HM, Zhang RJ, Shen CL. Illinois Jury Finds in Favor of Doctor in Gallbladder Surgery that Led to Fatal Bowel Perforation Nickl v. Barry S. Rosen, M.D. Unauthorized use of these marks is strictly prohibited. Clinical Orthopaedics and Related Research411:86-94, June 2003. FOIA Nottmeier EW, Seemer W, Young PM. 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. Unilateral nonunion was seen in three patients (2.7%), associated with implant failure in one of the patients. Balch CM, Oreskovich MR, Dyrbye LN, et al. Zucherman J, Hsu K, Picetti III G, et al: Clinical efficacy of spinal instrumentation in lumbar degenerative disc disease. These risks can be minimized by the judicious use of instrumentation by experienced surgeons for specific indications as supported by the literature. However, the misplacement of pedicle screws can lead to disastrous complications. There were two complete degenerations of the upper disc, one central canal stenosis, and two asymptomatic disc space narrowings and retrolistheses. Of note, the award amount for one settlement case was undisclosed. Determining legal responsibility in otolaryngology: a review of 44 trials since 2008. Defendant-awarded cases by US region (right). Review of neurosurgery medical professional liability claims in the United States. Although the rationale for using pedicle screw fixation is fairly clear, controversy continues regarding the application of pedicle instrumentation for spine arthrodesis, especially on the degenerative lumbar spine. J Spine Surg. Autor de la entrada Por ; Fecha de la entrada austin brown musician; matrix toners for bleached hair . Yuan HA, Garfin SR, Dickman CA, Mardjetko SM: A historical cohort study of pedicle screw fixation in thoracic, lumbar and sacral spinal fusions. Disc space narrowing was the most common problem after instrumented arthrodesis and was observed in 27 patients (24.1%). Sub-analysis of adolescent idiopathic scoliotic patients showed no curve or patient characteristic that correlated with IMP or SAR. Spine 16:576579, 1991. Plaintiff-awarded cases by US region (left). 1 To be effective, the pedicle screw constructs must withstand intraoperative loading and physiological forces due to daily postoperative activities. Call me tomorrow. 2014;20(2):196203. Harrington PR, Tullos HS: Reduction of severe spondylolisthesis in children. In six patients (5.3%) with degenerative spine disease, the disc material had been removed. One common area for the potential avoidance of malpractice claims and subsequent payouts involves misplaced pedicle and/or lateral mass instrumentation. Methods. 2012;7(6):e39237. The aim of this study is to evaluate the accuracy of pedicle screw insertion in spondylitis tuberculosis kyphosis correction using a freehand technique. 2022 Sep 15;14(9):6323-6331. eCollection 2022. 2. 2014;174(11):18671868. 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. Dr. Shaffrey has received grants from the NIH and Department of Defense. Neurosurgery. Junctional problems were recorded as pathologic changes of the adjacent motion segments, just above and below the instrumented and fused segments. Kreisman Law Offices has been handling Illinois surgical error lawsuits for individuals and families for more than 35 years in and around Chicago, Cook County and surrounding areas, including Batavia, Bellwood, Deerfield, Evanston, Franklin Park, and Lansing. It has a great developing technique that is used for fixation and fusion in spine surgery. Under the high-low agreement, Drs. Quraishi NA, Hammett TC, Todd DB, et al. Disclosures Dr. Karikari is a consultant for NuVasive, Globus, Johnson & Johnson, and DePuy and receives a spine fellowship fund from NuVasive. Int Orthop 20:3542, 1996. Pedicle screw insertions are commonly used for posterior fixation to treat various spine disorders. $ = US$; MW = Midwest; NE = Northeast; SE = Southeast; SW = Southwest; W = West. 144 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. George Sapkas, MD, DSc; and Panayiotis J. Papagelopoulis, MD, DScGuest Editors. In the Kane County medical malpractice lawsuit of Melissa Nyquist v. Dr. Taras Masnyk and DuPage Neurosurgery, S.C., 06 L 421, the plaintiffs attorney was unable to convince the jury that the plaintiffs medical complications were caused by the defendants negligence. J Neurosurg Spine. However, the highest offer had been a combined $300,000 from the two defendants. Achieving proper lumbar lordosis, evaluating any preexisting scoliosis, and intraoperative assessment with AP radiographs could prevent balance problems. The patient suffered permanent nerve damage as a result of the puncture. Cerebrospinal fluid fistulas. Despite these failures, solid spinal arthrodesis was obtained in all patients. 37. This decision must be made on a case-by-case basis at the surgeons and patients discretion after a thorough discussion of the associated risks and benefits of revision surgery. Error in trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults, Spinal fusion in the United States: analysis of trends from 1998 to 2008, Safety and efficacy of pedicle screw placement using intraoperative computed tomography: consecutive series of 1148 pedicle screws, The accuracy of pedicle screw placement using intraoperative image guidance systems, 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, 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, Use of the Airo mobile intraoperative CT system versus the O-arm for transpedicular screw fixation in the thoracic and lumbar spine: a retrospective cohort study of 263 patients, Accuracy and workflow of navigated spinal instrumentation with the mobile AIRO, Accuracy of pedicle screw placement and clinical outcomes of robot-assisted technique versus conventional freehand technique in spine surgery from nine randomized controlled trials: a meta-analysis, Safety and accuracy of robot-assisted versus fluoroscopy-guided pedicle screw insertion for degenerative diseases of the lumbar spine: a matched cohort comparison, Verdict/Settlement Search and Inclusion/Exclusion Criteria, Plaintiff Claim and Index Surgery Information, Impact of Medical Malpractice on Neurosurgeon and Orthopedic Surgeon Careers, Financial Burden of Medical Malpractice Claims Related to Misplaced Pedicle and/or Lateral Mass Screws, Frequency of Misplaced Pedicle and Lateral Mass Screws in Spine Surgery, Strategies to Improve the Accuracy of Screw Placement in Spine Surgery, Top 25 Cited Gamma Knife Surgery Articles - Trigeminal Neuralgia, Top 25 Cited Gamma Knife Surgery Articles - Volume 111, https://doi.org/10.3171/2020.8.FOCUS20600, https://www.bls.gov/data/inflation_calculator.htm, Volume 49 (2020): Issue 5 (Nov 2020): Medicolegal issues in neurosurgery, Single vs multiple misplaced screw(s), no. Krag MH, Beynnon BD, Pope MH, et al: An internal fixator for posterior application to short segment of the thoracic, lumbar, or lumbosacral spine. Debate Over Extent of Eye Damage Following Implant Lens Surgery Leads to $1 Million Verdict in Zaleski v Elmhurst Eye Surgery Center. Federal government websites often end in .gov or .mil. The third surgical procedure removed the pedicle screws but left the patient in an unfused state with an unstable spine. Spine 24:23522357, 1999. Adjusted for age and preoperative Cobb angle, patients with a higher misplacement rate were more likely to have screws . Seabury SA, Chandra A, Lakdawalla DN, Jena AB. Error in trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. Over 40% of patients had screws with either some/major concern. A neurologic deficit developed in one patient (0.9%) who had partial bilateral drop feet after reduction of L4L5 spondylolisthesis. Clin Orthop 203:126134, 1986. Epstein NE. 2014 Sep;21(3):320-8. doi: 10.3171/2014.5.SPINE13567. The patient had to undergo a subsequent surgery to remove the pedicles. I won't be at the office but I will check my voice mail. The plaintiff underwent revision surgery in May 2013. 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%). 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. 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. Two patients with associated injuries in the lower limbs had deep venous thrombosis develop, three patients had pneumonia develop, and four patients with neurologic impairment had urinary tract infections develop. These complications may have resulted from powerful bending movement acting on the screw at its entry point to the bone. 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. Jena AB, Seabury S, Lakdawalla D, Chandra A. This occurred on only one side and the correction achieved by the instrumentation was maintained. Quinnell RC, Stockdale HR: Some experimental observations of the influence of a single lumbar floating fusion on the remaining lumbar spine. Bydon M, Xu R, Amin AG, Macki M, Kaloostian P, Sciubba DM, Wolinsky JP, Bydon A, Gokaslan ZL, Witham TF. 20. Several limitations should be carefully considered when interpreting our results. (A) Anteroposterior and (B) lateral radiographs taken 2 years after surgery show unilateral pseudarthrosis in a 55-year-old man with spinal stenosis. The medicolegal landscape of spine surgery: how do surgeons fare? Fager CA. 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. Segal J. 2019;19(7):12211231. Percentage of cases per US region (center). Guzek RH, Mitchell SL, Krakow AR, Harshavardhana NS, Sarkissian EJ, Flynn JM. Despite this problem, the clinical result was excellent. In their meta-analysis of nine randomized controlled trials, Li et al. While the majority of verdicts are found in favor of the defendant (surgeon), over 30% of cases in this study were found in favor of the plaintiff (patient), resulting in average inflation-adjusted payouts of over $1.2 million per claim over the past 25 years. 1. This patient recovered completely in 6 weeks. Long spine fixation was necessary for patients with tuberculous spondylitis and metastatic disease. Clin Orthop 284:8090, 1992. 2020;11:38. The case facts centered on a spinal surgery the 34 year-old plaintiff had undergone at Central DuPage Hospital. It was firstly introduced by Harrington and Tullos in 1969 and then in late 1980s developed by Roy Camille et al., Louis, and Steffe. 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. In addition, the median time to judgment is substantial, particularly for defendant verdicts, spanning over 4.5 years from the time of surgery. (A) Anteroposterior and (B) lateral radiographs show coronal imbalance that developed 4 years after surgery in a 57-year-old woman with L3L4 float fusion. A total of 247 screws (9.07%) were BMP, 52 (1.91%) were IMP, and 29 (1.06%) were considered SAR. Safety and efficacy of pedicle screw placement using intraoperative computed tomography: consecutive series of 1148 pedicle screws. Conclusion: The median time to case closure was 56.3 (35.267.2) months when ruled in favor of the plaintiff (i.e., patient) compared to 61.5 (51.477.2) months for defendant (surgeon) verdicts (p = 0.117). Finally, considering the problems of balance, it seems that failure to properly evaluate any preexisting scoliosis was a main cause of this important complication. doi: 10.1097/BRS.0b013e31822a2e0a. Spine J. PURPOSE This study aimed to compare rates of perioperative complications between robotic-assisted and conventional . Once the spine is exposed, the appropriate levels of fixation are confirmed with the image intensifier. In the current series, including general complications, only 48 patients (43%) had no notable complication and the remaining 64 patients (57%) had one or more complications. J Bone Joint Surg 45A:11591170, 1963. Spine (Phila Pa 1976). Deyo RA, Mirza SK, Martin BI. Spinal fusion procedures are increasingly performed each year, with Deyo et al. Neurosurgery. National Library of Medicine Mukherjee S, Pringle C, Crocker M. A nine-year review of medicolegal claims in neurosurgery. 2018;41(5):e615e620. Legal liability in iatrogenic orbital injury. Am J Transl Res. 15. You are talking one of the most complicated area of the law. 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? What can spine surgeons do to improve patient care and avoid medical negligence suits? To prevent the development of pseudarthrosis, we think it is important for surgeons to apply the following five technical principles: the proper-sized pedicle screw has to be inserted on the first attempt; repeated manipulation in setting instruments must be avoided; anterior penetration of the screw into the sacrum and insertion of two screws in each side are advocated for fixing the lumbosacral junction; industrious and detailed decortication of the posterior elements must be developed fully; and the use of autologous bone graft is recommended. Cotrel Y, Dubousset J, Guillaumat M: New universal instrumentation in spinal surgery. 14. Hsu K, Zucherman JF, White AH: Internal Fixation With Pedicle Screws. Thus, in the current study we aimed to describe this impact in the US, as well as to suggest a potential method for mitigating the problem. 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. 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. J Bone Joint Surg 61A:201207, 1979. 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). 1). 2011;306(10):1088. N Engl J Med. 2017;31(3):287288. However, despite the apparent widespread use of pedicle system fixation, few studies of problems and particularly complications have been published. 2009;10(1):3339. Johnston II CE, Ashman RB, Baird AM, Allard RN: Effect of spinal construct stiffness on early fusion mass incorporation: Experimental study. A total of 2724 screws were placed in 127 patients. Under this theory of liability, the plaintiff needed to not only establish that she had experienced foot drop, a fact that no one was disputing, but that it was caused by the defendants negligence. Epub 2021 Aug 28. The incidence of screw failure, which can occur despite solid arthrodesis, 7 in the current series was 8% and mainly involved patients with thoracolumbar injury. Am J Orthop. Pedicle instrumentation in the thoracolumbar and lumbar spine is a technically challenging procedure. However, following the spinal fusion, Nyquist began to experience foot drop in her right foot. Complete degeneration of the upper disc developed in two patients who had spinal stenosis and degenerative scoliosis. 31. 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. 2018;27(9):23392347. The literature gave a range of screw misplacement rates detected on postoperative imaging of between 1% and 18%, with the rate generally considered to be around 10%. Spine 19(20 Suppl):2279S2296, 1994. Your current browser may not support copying via this button. Spine neurosurgeons facing the judicialization of their profession: disenchantment and alteration of daily practicea qualitative study. 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. Ann Thorac Surg. (%), Pseudarthrosis requiring revision surgery. pedicle screw misplacement malpractice. General complications were considered those developing during and after surgery that were not directly related to instrumentation. In patients with degenerative conditions, all of the affected segments were included in the instrumentation and each vertebra was fixed with two pedicle screws. 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. 36. 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. Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. 33. Studdert DM, Mello MM, Sage WM, et al. J Bone Joint Surg 73A:11791184, 1991. Litigation resulted in average payouts of $1,204,422 $753,832 between 1995 and 2019, when adjusted for inflation. The accuracy of pedicle screw placement using intraoperative image guidance systems. Disclaimer. Defensive medicine in U.S. spine neurosurgery. Hadjipavlou A, Enker P, Dupuis P, Katzman S, Silver J: The causes of failure of lumbar transpedicular spinal instrumentation and fusion: A prospective study. Results. 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. J Bone Joint Surg 62A:13021307, 1980. Descriptive analysis of state and federal spine surgery malpractice litigation in the United States. An official website of the United States government. The initial search using the terms above returned 3654 cases. Overall reported screw misplacement is low, but it does not reflect the potential impact on patient morbidity. 6 Orthopedics. Surg Neurol Int. 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. Neurologic injury. 1,12,19,22 The largest series of adjacent segment breakdown was reported by Schlegel et al. 3,4,9,29,34 In addition, developments in surgical technique and implant design have decreased operative risk and implant-related complications. Pedicle screw insertion in the thoracolumbar spine. Makhni MC, Park PJ, Jimenez J, et al. Fortunately, most of the complications were minor and transient. 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. 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. 22. Three-dimensional printing versus freehand surgical techniques in the surgical management of adolescent idiopathic spinal deformity. Preparation. Please do not include any confidential or sensitive information in a contact form, text message, or voicemail. Please enable it to take advantage of the complete set of features! NCI CPTC Antibody Characterization Program. Forty-seven general complications were seen in 41 patients (36.5%). In White AH, Rothman RH, Ray CD (eds). A rod is used to hold the vertebra together to allow fusion to occur. Cook County Surgeons Cut Common BIle Duct During Surgery, But Jury Finds for Defendants Irwin v. Alan Loren, M.D. Show more. Steinmann JC, Herkowitz HN: Pseudarthrosis of the spine. The remaining eight patients, including two patients with spinal trauma, five patients with infection, and one patient with a tumor, had anterior and posterior procedures. In the other patient, L4L5 float arthrodesis was done. The https:// ensures that you are connecting to the You may be trying to access this site from a secured browser on the server. Defensive medicine in neurosurgery: the Canadian experience. 32. 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.

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