Misplacement of Pedicle Screws

40 y/o female. Surgery in Oct. 2011 for decompression at L 2-3 and L-5 – S1 fusion with instrumentation. After surgery she could not move left foot at all. Eventually got some feeling and motor back. Now walks with a cane – significant pain. Surgeon wanted to go back in for exploratory. Patient went for 2nd opinion and was told that 2 screws were misplaced – one in psoas muscle and one into nerve. Both subsequent opinion Drs. counseled against removing hardware or screws as they are too close to vena cava. Had DVTs right leg 1990 and 2010 and DVT left leg after this surgery. She is factor 5, Leiden and on Coumadin – 30 mg per day

Issue
Whether misplacement of the screws was below standard of care and, if so, did it cause neurological deficit.

medQuest Expert Opinions:

This likely has merit, but it depends on the imaging. If indeed the screw went through a nerve, that is outside the SOC. The psoas screw and closeness to the IVC is more questionable. Again, depends on the records and imaging on CD.
DR SS –  Neurosurgeon

The postop imaging will be the key to this case. I believe the standard of care allows for a certain degree of imprecision in placement of pedicle screws; but there are certain cases where the placement is so poor that they would be evidence of a departure as is likely the case here.
DR JH – Neurosurgeon