Dr. Erik Spayde, Spine Surgeon, Unveils the Future of Outpatient Spine Surgery with NANISX
December 26, 2023
In the dynamic healthcare landscape, where innovation and efficiency are paramount, we are energized to introduce NANISX, a pioneering global medical device company leading the way in outpatient spine surgery.
Imagine a future where outpatient spine surgery is the standard, driven by cutting-edge technology and revolutionary techniques. NANISX stands at the forefront, shaping this vision with our state-of-the-art portfolio of spinal devices and our commitment to Less Exposure Spine Surgery (LESS) techniques.
Neurosurgeons and orthopedic spine surgeons undertake highly intricate surgeries in the vicinity of the spinal cord and nerves, which are exceptionally delicate structures. Patients often arrive with debilitating symptoms such as pain, numbness, weakness, and in severe cases, even paralysis and loss of bowel and bladder functions. Many patients, despite being aware of the associated risks, choose to undergo surgery as they deem it preferable to living with their disabling spine conditions. These risks are frequently gleaned from online research or conversations with other patients who have undergone similar procedures.
Subsequently, the spine surgeon and their team engage in a detailed discussion with the patient, providing comprehensive explanations regarding the potential risks. Before any surgery, it is standard practice for the patient to sign a legal consent document. Without this signed consent, the surgeon cannot proceed with the operation. The consent form outlines the various risks, which may include issues like loosening or breakage of screws or other hardware, nerve injuries, spinal cord injury, weakness, numbness, paralysis, and, in rare cases, even the risk of death. This formalized process ensures that patients are fully informed about the potential outcomes and are actively involved in the decision-making process regarding their medical treatment.
“Expect to see more pedicle screw copycat lawsuits as more screws are placed in the spine encouraged by industry pushing navigation and robots to aid in pedicle screw placement rather than total disc replacement or interspinous fixation as alternatives that require no screws”
— Dr Chin
So why do surgeons get sued by patients after spine surgery? Because of the money to be made from accusing doctors and forcing them to defend their surgeries and reputations in front of a jury that may sympathize with the patient and be convinced by the expert witness testimony. It is easy for a patient to believe a surgeon who sits on the witness stand and takes an oath to tell the truth. Is the surgeon incentivized? “What the patients don’t know is that in order for the lawsuit to get to court, the lawyers need expert surgeons willing to support the case. These expert surgeons are paid on average over $500 per hour, travel expenses on average of $10,000 per day to appear in court” said Dr. Chin. This is a lucrative business for surgeons who make a living as expert witnesses.
There are some counties in the US such as Philadelphia in Pennsylvania and Miami-Dade Country in South Florida that are so inclined to award large payouts to anyone claiming an injury that an accused surgeon is compelled to settle or be considered foolish to attempt to go to court to get a fair trial. In one article looking at medicolegal cases against spine surgeons it was shown that neurosurgeons and orthopedic surgeons were equally named as the defendant (n = 32 and 31, respectively), in spine malpractice cases and cases were most commonly due to misplaced lumbar pedicle screws. Average payouts were over $1 M ($1,204,422 ± $753,832) between 1995 and 2019, when adjusted for inflation. These are large sums of money ready to be awarded in sympathy to patients who enter the court room limping in pain or sitting in a wheelchair. Lawyers know their case depends on the willingness of surgeons to be paid for their testimony to support their claims, so they find the plaintiff surgeons for sale who are willing to support the case in return for thousands of dollars in payments. The unsuspecting jury is inclined to believe the experts as independent doctors while suspecting the accused surgeon as a bad doctor who hurt the patient.
The other reason I found is the copycat cases. Lawyers search for cases and look for patients willing to file suit for similar surgeries and make similar claims. In a recent case a jury awarded $4.5 M for a claim of a misplaced pedicle screw against a neurosurgeon and orthopedic surgeon who did the surgery together. The plaintiff hired experts supported the patient claim for damages due to pain in the right leg, numbness in the right calf, and weakness in the right toes.
Accused breach of the left L5 pedicle screw causing S1 numbness and back pain
I was accused of allegedly breaching the L5 pedicle with a pedicle screw leading to a patient suffering from chronic S1 nerve injury confirmed on EMG/NCV studies. From this EMG/NCV studies, a board-certified neurologist found no L5 nerve root injury yet, two spine surgeon plaintiff experts testified that the L5 screw was misplaced medially in the canal and caused the patient's S1 nerve symptoms. One of the experts removed the screws but claimed they entered the canal and witnessed the breach before removing the screws. However, entering the canal is impossible without first removing the midline mediolaterally placed cortical screws. The case was decided for the plaintiff. We filed an appeal.
So, are these screw lawsuits a new trend? It is a trend, but it is not new. Over 3,000 pedicle screw lawsuits were filed in the 90’s against surgeons who performed pedicle screw surgeries and spine societies whose educational programs supported pedicle screws.
Copycat spine cases apply to any screw used in spine surgery. Beware of lateral mass screw copycat lawsuits. In about 2006, when I was at the University of Pennsylvania, I was accused of an alleged misplaced lateral mass screw that impinged a vertebral artery leading to the patient having post operative pain and numbness after revision posterior cervical decompression and fusion for myelopathy and a pseudomeningocele from previous multiple surgeries. They had an expert willing to testify that the tip of one lateral mass screw was against the vertebral artery. In our defense we requested a CT scan to confirm but the plaintiff lawyer refused and took us to court. Our lawyers decided it was too risky to defend the case in the Philadelphia court system, so they settled. This case is now in the records for other lawyers to copy if they find a patient who had posterior cervical fusion with lateral mass screws.
I was an expert witness for a neurosurgeon sued due to placing long pedicle screws at S1 on both sides. The patient reported worsening back and bilateral leg pain immediately after surgery, and imaging studies confirmed the long screws. Their expert transferred the patient to a competing hospital, where they revised all the screws and claimed the long S1 screws were responsible for the patient's post-operative pain. Ironically, the revised surgery showed that the one L5 screws and both S1 screws were long, breaching the lateral cortex and extending into the psoas muscle.
"Expect to see more pedicle screw copycat lawsuits as more screws are placed in the spine encouraged by industry pushing navigation and robots to aid in pedicle screw placement rather than total disc replacement or interspinous fixation as alternatives that require no screws." We are being dragged into a net where if you use navigation or robots and your pedicle screw is not perfect you will risk a lawsuit and if you use traditional methods and you have a misplaced screw you also risk being sued since navigation and robots were not used. Furthermore, many patients after pedicle screws are seen by pain management doctors who will be offering non-pedicle screw options for their back and leg pain. The question will be asked did we have to use pedicle screws? What about disc replacement or interspinous fixation?
I believe you will see surgeons retiring early or changing careers to go their master’s in business administration (MBA) due to malpractice lawsuits and other financial pressures.