This case involves a woman that had undergone spinal fusion surgery with pedicle screw placement. The patient underwent revision surgery several years later at another facility. The treating physician removed all the previous pedicle screws and extended the fusion. The patient experienced postoperative numbness in her legs that was dismissed as a common side effect of the surgery. In the 2 months following the surgery, the patient had 3 spinal X-rays that were read as normal. The patient continued to experience numbness with burning and pain and sought another physician’s opinion. 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. The patient had to undergo a subsequent surgery to remove the pedicles. The patient suffered permanent nerve damage as a result of the puncture. In spite of spinal cord stimulators and rehabilitation, the patient continued to experience persistent back pain.
Question(s) For Expert Witness
- 1. How often do you perform spinal lumbar fusion surgeries?
- 2. What precautions are taken to avoid misplacement of the pedicle screws?
- 3. If you have normal intraoperative neuromonitoring, what postoperative symptoms would prompt you to consider the possibility of screw misplacement?
Expert Witness Response E-007022
I am a board-certified orthopedic surgeon who is fellowship trained in spinal surgery. I am on faculty at a major medical school and practice at a large academic medical center. I routinely perform lumbar fusion surgeries several times a month. I use intraoperative imaging, including navigation as well as neuromonitoring as methods to minimize the risk of screw misplacement. I believe that symptoms of significant lower extremity pain, numbness, and/or weakness following fusion surgery would warrant further imaging including CT/MRI. I have reviewed multiple cases in which patients allegedly experienced neurologic symptoms resulting from misplaced lumbar pedicle screws.