The patient had a history of lumbar back pain, and underwent a decompression and fusion surgery in three lumbar vertebrae. It was staged with an anterior approach one day and a posterior approach a week later. The pt has since had extreme back pain with weakness and is now wheelchair dependent, as he can only walk for 2-3 minutes at a time. Not being a candidate for additional back surgery, his only option is long term opiates. His radiographs show that one of the pedicle screws is not in the pedicle at all, and two of the screws have some impingement on the spinal canal – the source of his pain. Is it a deviation from the standard of care to place the pedicle screws such that they either are not in the pedicle, or such that they impinge on the spinal column? Is it a deviation from the standard of care to place the pedicle screws such that they either are not in the pedicle, or such that they impinge on the spinal column?
MEDQUEST EXPERT RESPONSES:
Spinal hardware cannot be placed perfectly in every instance, so some degree of imprecision is acceptable. Whether a malpositioned pedicle screw is negligence depends how seriously the screw is out of the desired space, and whether the proper safeguards were in place. If a screw is actually pressing on a nerve and is only discovered following surgery, it should be promptly corrected. The imaging and the op report are critical as to whether the standard of care was violated. DR JH – Neurosurgeon
Depends where the screws are. Would need to see medicals including imaging on CD. Unlikely the case has much merit. Dr SS
I have represented patients with lumbar fusions and pedicle screw placement. Success in these cases depends on whether the proper safeguards were in place. Misplaced pedicle screws in and of themselves do not make a case.