1Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina; and.
2ProKarma Inc., Omaha, Nebraska.
Neurosurg Focus. 2020 Nov;49(5):E20. doi: 10.3171/2020.8.FOCUS20600.
Spine surgery has been disproportionately impacted by medical liability and malpractice litigation, with the majority of claims and payouts related to procedural error. One common area for the potential avoidance of malpractice claims and subsequent payouts involves misplaced pedicle and/or lateral mass instrumentation. However, the medicolegal impact of misplaced screws on spine surgery has not been directly reported in the literature. 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.This retrospective analysis of 68 closed medicolegal cases related to misplaced screws in spine surgery showed that neurosurgeons and orthopedic spine surgeons were equally named as the defendant (n = 32 and 31, respectively), and cases were most commonly due to misplaced lumbar pedicle screws (n = 41, 60.3%). Litigation resulted in average payouts of $1,204,422 ± $753,832 between 1995 and 2019, when adjusted for inflation. The median time to case closure was 56.3 (35.2-67.2) months when ruled in favor of the plaintiff (i.e., patient) compared to 61.5 (51.4-77.2) months for defendant (surgeon) verdicts (p = 0.117).
脊柱外科手术受到医疗责任和医疗事故诉讼的不成比例的影响，大多数索赔和理赔都与程序错误有关。一个潜在的避免医疗事故索赔和随后理赔的常见领域涉及到椎弓根和/或侧块器械的错位。然而，文献中尚未直接报道螺钉错位对脊柱手术的法医学影响。本研究的作者旨在描述美国的这种影响，并提出一种潜在的方法来减轻这一问题。
这项回顾性分析了 68 例与脊柱手术中螺钉错位相关的已结案医疗事故案例，结果显示，神经外科医生和骨科脊柱外科医生同样被列为被告（分别为 32 名和 31 名），且大多数案例是由于腰椎椎弓根螺钉错位（41 例，60.3%）。1995 年至 2019 年，经通胀调整后，诉讼的平均赔偿金额为 1,204,422 美元±753,832 美元。当有利于原告（即患者）时，案件结案的中位数时间为 56.3（35.2-67.2）个月，而有利于被告（外科医生）的裁决为 61.5（51.4-77.2）个月（p = 0.117）。
