Of note, the award amount for one settlement case was undisclosed. shooting in valdosta leaves one dead Spine 18:18621866, 1993. 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. 3. Results: A total of 2724 screws were placed in 127 patients. Ann Thorac Surg. Retrospective analysis of reasons and revision strategy for failed thoracolumbar fracture surgery by posterior approach: a series of 31 cases. NCI CPTC Antibody Characterization Program. Characteristics of medicolegal cases related to misplaced screws in spine surgery. 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. 2. 2018;43(14):984990. Clin Orthop 284:8090, 1992. It is an effective procedure in that it provides an almost immediate stabilization of the spine [ 2-5 ]. Using Low-Dose, Biplanar Imaging to Reduce Screw Misplacement. 2012;7(6):e39237. 9. * Quinnell RC, Stockdale HR: Some experimental observations of the influence of a single lumbar floating fusion on the remaining lumbar spine. Spine 6:263267, 1981. Complete degeneration of the upper disc developed in two patients who had spinal stenosis and degenerative scoliosis. Don't jump in get legal help. 2 One of the first obstacles regarding . 37. Spine 17:349355, 1992. Friedlander and Bradley will pay half of the $2.25 million. 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). All these problems were observed only just above the upper instrumentation level and all were observed in patients older than 55 years. Epub 2014 Apr 4. This demonstrates technical ability but does not represent the impact of screw misplacement on individual patients. Feb. 16, 2021 Accurate placement of pedicle screws is key to avoiding the potential complications of spinal fusion surgery and improving overall spinal fixation. Phone/Fax: 30-2810-318361; E-mail: [emailprotected]. 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 . Saillant G: Etude anatomique des pedicules vertebraux: Application chirurgicale. The physician ordered an MRI of the lumbar spine which showed that the screws had been misplaced and were puncturing the patient's lumbar nerves. Dr. Goodwin has received grants from the Burroughs Wellcome Fund, North Carolina Spine Society, and Robert Wood Johnson Harold Amos Medical Faculty Development Program and the NIH/NINDS K12 NRCDP Physician Scientist Award. The https:// ensures that you are connecting to the 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. Spine (Phila Pa 1976). 2018;18(2):209215. 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. 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. 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. 2. 2016;102(2):358362. Risk factor analysis showed smaller Cobb angles increased likelihood of all screws being AP. Ann R Coll Surg Engl. Todd NV. Balch CM, Oreskovich MR, Dyrbye LN, et al. However, following the spinal fusion, Nyquist began to experience foot drop in her right foot. Hsu K, Zucherman JF, White AH: Internal Fixation With Pedicle Screws. The link was not copied. The aim of this study is to evaluate the accuracy of pedicle screw insertion in spondylitis tuberculosis kyphosis correction using a freehand technique. J Bone Joint Surg 45A:11591170, 1963. This study revealed an overall accuracy rate of 95.2% of mainly percutaneously inserted pedicle screws according to the classification of Zdichavsky et al. Fager CA. This step in implant evolution was inevitable, because prior phases of implant development did not control each plane of motion segment stress. 23. The purpose of current study was to analyze the complications and problems during and after pedicle screw fixation for various spinal disorders and trauma. McLaughlin WM, Donnelley CA, Yu K, Gillinov SM, Tuason DA. Waddell G, Kummell EG, Lotto WN, et al: Failed lumbar disc surgery and repeat surgery following industrial injuries. 2014;20(2):196203. Judgment information associated with a defendant (surgeon) versus plaintiff (patient) ruling, trial versus settlement versus arbitration decision, award amount, and time to decision or case closure from index surgery was also recorded. 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. General complications were considered those developing during and after surgery that were not directly related to instrumentation. Hecht N, Kamphuis M, Czabanka M, 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. The rod is held in place by "pedicle screws," which the surgeon must insert into the pedicles. Mean amounts awarded SD to plaintiffs by jury trial (n = 13) versus settlement/arbitration (n = 7), adjusted for inflation as of April 2020. 2020;45(2):E111E119. This site needs JavaScript to work properly. 2021 Jul 1;41(Suppl 1):S80-S86. 2016;25(3):716723. Your current browser may not support copying via this button. In situ spine arthrodesis permits load sharing by the vertebral bodies, preventing fatigue failure of the implant. 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. Can Postoperative Radiographs Accurately Identify Screw Misplacements? Two patients had early postoperative postural headache that disappeared after removal of the misplaced screw. Defensive medicine in neurosurgery: the Canadian experience. Summary of background data: J Neurosurg Spine. 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. Larson AN, Santos ER, Polly DW Jr, Ledonio CG, Sembrano JN, Mielke CH, Guidera KJ. 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 PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Reviewed submitted version of manuscript: all authors. Safety and accuracy of robot-assisted versus fluoroscopy-guided pedicle screw insertion for degenerative diseases of the lumbar spine: a matched cohort comparison. 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. 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. 2018;29(4):397406. Methods: Spine 13:952953, 1988. Int Orthop 20:3542, 1996. Copyright © 2023 Becker's Healthcare. Personal consequences of malpractice lawsuits on American surgeons. Scarone P, Vincenzo G, Distefano D, et al. Hardware-related failures were observed in 12 patients (10.7%). Before Grubb SA, Lipscomb HJ: Results of lumbosacral fusion for degenerative disc disease with and without instrumentation: Two- to five-year follow-up. A retrospective review of charts, x-rays (XRs) and computed tomography (CT) scans was performed. Spine 18:11601172, 1993. 2. Forty-seven intraoperative and medical complications were observed in 41 patients (36.6%). Accuracy of C2 pedicle screw placement using the anatomic freehand technique. 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. Thirty-five (27.56%) had IMP and 18 (14.17%) had SAR. 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. Instrumentation removal is an option for patients with successful arthrodesis, but remains controversial. 2011;306(10):1088. Pedicle screw insertions are commonly used for posterior fixation to treat various spine disorders, deformities, and trauma. Of note, while only 38.2% (n = 26) of cases in our study mentioned the use of intraoperative radiographic confirmation, only one of these cases reported that the misplaced screw had been caught prior to leaving the operating room, which had resulted in an inadvertent dural tear and L5 nerve root injury. 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. Thus, we are unable to comment on whether all misplaced screws, particularly when asymptomatic, should be revised in an effort to prevent litigation. Defensive medicine in U.S. spine neurosurgery. Plaintiff's expert was prepared to testify at trial that these complaints are characteristic of a malpositioned screw impinging upon a neural structure. 2012 Feb 1;37(3):E188-94. 6 Drs. Gertzbein SD, Robbins SE: Accuracy of pedicular screw placement in vivo. 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. 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. Seabury SA, Chandra A, Lakdawalla DN, Jena AB. Subjects were 10,754 patients (73,777 pedicle screws) who underwent PSF at 11 hospitals over 15 years. Malpractice issues in neurological surgery. 35. West III JL, Bradford DS, Ogilvie JW: Complications of the variable screw pedicle screw fixation. J Neurosurg Spine. 2014;96(4):266270. Screws penetrating the anterior cortex and abutting vascular structures, particularly aortic abutment with left-sided screws, which can lead to erosion and pseudoaneurysms. Likewise, cases are uploaded on a voluntary basis by state and federal judges and courts, which may lead to selection bias. 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. Melissa Nyquist required a lumbar back fusion for a herniated disc at the L4-5 level. These numbers are in line with the current literature. It has a great developing technique that is used for fixation and fusion in spine surgery. On average, physicians spend nearly 11 percent of their 40-year careers with an open, unresolved malpractice claim. Lorenz M, Zindrick M, Schwaegler P, et al: A comparison of single level fusion with and without hardware. Malpractice claims in spine surgery in Germany: a 5-year analysis. 15. The majority of screws were misplaced in the lumbar spine for both plaintiff- and defendant-awarded cases (66.7% vs 57.4%, respectively, p = 0.564; Table 1). All the operations were done by one surgeon (PK). Acta Neurochir (Wien). Am J Transl Res. 39. 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. 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. SECTION I SYMPOSIUM: Advances in Spine Surgery, Distribution of Spinal Disorders in 112 Patients, Classification of Complications in 64 patients. 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. JAMA. Fortunately, most of the complications were minor and transient. 2014;21(3):320328. 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. 1. Despite commonly used, questions remain about their safety especially for the thoracic spine and in deformity where difficulty in positioning can lead to pedicle breach and adjacent structures injury. Laryngoscope. The intent is to provide relief from pain and nerve damage. 15. 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. Please try after some time. Spine 13:10121018, 1988. Except for two patients with spinal metastatic disease, all other patients received an iliac crest autologous bone grafts. Objective: 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. Accuracy of fluoroscopically-assisted pedicle screw placement: analysis of 1,218 screws in 198 patients. All the incidental dural tears were repaired immediately and produced no clinical sequelae. 0 attorneys agreed. An official website of the United States government. 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. Deyo RA, Mirza SK, Martin BI. Federal government websites often end in .gov or .mil. 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. $ = US$; MW = Midwest; NE = Northeast; SE = Southeast; SW = Southwest; W = West. On April 6, a Union County, N.J., jury awarded a plaintiff $4.5 million over a botched spine surgery. However, this is the first study to evaluate the direct medicolegal impact of misplaced pedicle and lateral mass screws on spine surgery in the US and presents important information that may support the routine use of intraoperative imaging confirmation (via 3D fluoroscopy or intraoperative CT) and/or navigated screw placement (either computer- or robot-assisted) as a potential method to decrease the risk of future litigation during spinal fusion procedures. 11. Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. Routine CT scans were taken in all patients. To investigate intraoperative reinsertion of percutaneous pedicle screw (PPS) with intraoperative CT-based navigation and to evaluate the rate of deviation of PPS at postoperative radiographic examination. 3. Litigation resulted in average payouts of $1,204,422 $753,832 between 1995 and 2019, when adjusted for inflation. Screw Malposition: Are There Long-term Repercussions to Malposition of Pedicle Screws? Abstract BACKGROUND CONTEXT Surgeons have increasingly adopted robotic-assisted lumbar spinal fusion due to indications that robotic-assisted surgery can reduce pedicle screw misplacement. INCLUDE WHEN CITING DOI: 10.3171/2020.8.FOCUS20600. Per-patient analysis showed 23 (18.11%) of patients had all screws AP. Forty-seven general complications were seen in 41 patients (36.5%). 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). J Spinal Disord Tech. The remaining two patients had asymptomatic junctional problems develop after two- and three-segment fusions, at the third and fourth postoperative year, respectively. Agarwal N, Gupta R, Agarwal P, et al. Neurosurgery. 20. Segal J. Unauthorized use of these marks is strictly prohibited. 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. However, the highest offer had been a combined $300,000 from the two defendants. Spine arthrodesis was evaluated with plain AP and lateral radiographs taken 1 year after surgery. J Neurosurg. Placement of the pedicle screws in the thoracolumbar and lumbar spine is a technically demanding procedure. sharing sensitive information, make sure youre on a federal However, only a few complications were related to a poor clinical outcome. Medical malpractice in orthopedic surgery: a Westlaw-based demographic analysis. Disc space narrowing was the most common problem after instrumented arthrodesis and was observed in 27 patients (24.1%). A total of 247 screws (9.07%) were BMP, 52 (1.91%) were IMP, and 29 (1.06%) were considered SAR. 8,24,25,32. [] Computer-assisted computed tomography (CT) techniques have improved the overall accuracy for pedicle screw placement, and has reduced complication rates. [] The accuracy for free-hand screw placement technique varies from 69% to 94%. Pediatric pedicle screw placement using intraoperative computed tomography and 3-dimensional image-guided navigation. Pedicle screw instrumentation is widely used for the stabilization of the subaxial cervical, thoracic, and lumbar spine. J Neurosurg Spine. 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. Surg Neurol Int. 34. Pitfall: Unstable injuries. Twenty-one patients (18.8%) had thoracolumbar injuries, and loss of immediate postoperative deformity correction ranged from 1.4 to 4.5. In the current series, there were no cases of screw misplacement or vascular or neurologic complications caused by implant application. Steinmann JC, Herkowitz HN: Pseudarthrosis of the spine. Smith TR, Hulou MM, Yan SC, et al. Ultimately, no significant differences in case demographics were found between plaintiff and defendant judgments (Table 1). 1). In their meta-analysis of nine randomized controlled trials, Li et al. 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. J Bone Joint Surg 73A:11791184, 1991. 3). Cerebrospinal fluid fistulas. Insuring spinal neurosurgery. Conclusion: A retrospective review of charts, XRs and low-dose CT scans of 127 patients who underwent spinal fusion with pedicle screws for spinal deformity was performed. The screws were needed to stabilize the spine and fix the fused vertebrae in place. Katonis, Pavlos MD*; Christoforakis, Joseph MD*; Aligizakis, Agisilaos C. MD*; Papadopoulos, Charalampos MD*; Sapkas, George MD, DSc**; Hadjipavlou, Alexander MD*. 28. Percentage of cases per US region (center). Pedicle screw construct have become one of the most practiced procedure in spinal surgery. Rothberg MB, Class J, Bishop TF, et al. 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. 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. 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. Patient safety: disclosure of medical errors and risk mitigation. 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. 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. Spine surgery has been disproportionately impacted by medical liability and malpractice litigation, with the majority of claims and payouts related to procedural error. Morphometric analysis of the proximal thoracic pedicles in Lenke II and IV adolescent idiopathic scoliosis: an evaluation of the feasibility for pedicle screw insertion. Unfortunately, the plaintiffs attorney was unable to offer an alternative theory of surgical negligence that would refute the defendants explanation. Neurologic injury. Malpractice litigation and the spine: the NHS perspective on 235 successful claims in England. Louw JA, Dommissee GF, Roos MF: Spinal stenosis following anterior spinal fusion. Nyquist followed a medical malpractice lawsuit against Dr. Masnyk for his surgical error, alleging that the surgeon had improperly positioned the right L4 pedicel screw which had resulted in a nerve root injury and Nyquists subsequent foot drop. However, the impact of robotic-assisted spinal fusion on patient outcomes is less clear. Studies have shown that the greatest proportion of malpractice claims in spine surgery are related to procedural error,10,11,14,16,17,19 often resulting in the highest payouts.11,20 For spine surgery, one common area for the potential avoidance of malpractice claims and subsequent payouts involves misplaced pedicle and/or lateral mass screws, which occurs in approximately 14%55% of cases using standard techniques and results in neurological injury and/or durotomy in approximately 1%8% of cases.21 Misplaced screws have the potential to cause severe and sometimes permanent neurological deficits, including spinal cord and/or nerve root injury,21 as well as to decrease the stability of the fusion construct, leading to delayed complications related to pseudarthrosis. Problems in the instrumented segments were considered those occurring from narrowing of the disc space greater than 3 mm, pseudarthrosis, and loss of reduction. 31. 7. 2020;162(6):13791387. Potential complications may include increased pain, infection, or mechanical . Crawford MJ, Esses SI: Indications for pedicle fixation: Results of NASS/SRS faculty questionnaire: North American Spine Society and Scoliosis Research Society. Analysis and interpretation of data: Sankey, TT Than. Both of these patients complained of thigh pain but refused any additional surgery. Pedicle screw fixation is an effective but demanding method to treat various spinal disorders and is associated with a significant complication rate. Accuracy and workflow of navigated spinal instrumentation with the mobile AIRO CT scanner. Pedicle screws have been used to treat spinal disorders, including those caused by spinal cancer, congenital anomalies, trauma, and chronic pain syndromes. Svider PF, Husain Q, Kovalerchik O, et al. 4. 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%). 10. Sub-analysis of adolescent idiopathic scoliotic patients showed no curve or patient characteristic that correlated with IMP or SAR.
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