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Wrong-level surgery: A unique problem in spine surgery.

Hsiang J - Surg Neurol Int (2011)

Bottom Line: The current method to prevent wrong level spine surgery performed is mainly relied on intra-operative X-ray.There are situations that even with intraoperative X-ray, correct level still cannot be reliably identified.Examples of patient whose surgery can easily be performed on the wrong level are illustrated.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Spine Center, Swedish Neuroscience Institute, 550 17 Ave., Suite 500, Seattle, WA 98122, USA.

ABSTRACT

Background: Even though a lot of effort has gone into preventing operating at the wrong site and wrong patient, wrong-level surgery is a unique problem in spine surgery.

Methods: The current method to prevent wrong level spine surgery performed is mainly relied on intra-operative X-ray. Unfortunately, because of the unique features and anatomy of the spinal column, wrong level spine surgery still happens. There are situations that even with intraoperative X-ray, correct level still cannot be reliably identified.

Results: Examples of patient whose surgery can easily be performed on the wrong level are illustrated. A protocol to prevent wrong-level spine surgery preformed is developed.

Conclusion: The consequence of wrong-level spine surgery not only generates another surgery of the intended level; it is usually also associated with lawsuit. Strictly following this protocol can prevent wrong-level spine surgery.

No MeSH data available.


Related in: MedlinePlus

T2-weighed sagittal MRI showing a calcified T7-T8 disc compressing on the spinal cord
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Figure 1: T2-weighed sagittal MRI showing a calcified T7-T8 disc compressing on the spinal cord

Mentions: So far the published articles emphasize on “intraoperative imaging after exposure and marking of a fixed anatomic structure” to prevent wrong level spine surgery,[14] but there are situations even this measure would not be enough. Here illustrates two thoracic spine surgeries which posed difficulty in determining the correct levels during the surgery. Without the help of computer-assisted image guidance, different measures are generated in order to make sure the correct levels were operated. The first case is about a patient who had a T7--T8 calcified disc fragment that compressed on the spinal cord [Figure 1]. Because the bony anatomy was normal in this case, it would be difficult to locate the disc level of T7--T8 during the surgery by using intra-operative X-ray only. Request was made to the interventional radiologist to place fiducial markers at the right T7 and T8 pedicle before the surgery, thus facilitating in identifying the correct levels during the surgery [Figure 2].


Wrong-level surgery: A unique problem in spine surgery.

Hsiang J - Surg Neurol Int (2011)

T2-weighed sagittal MRI showing a calcified T7-T8 disc compressing on the spinal cord
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3108446&req=5

Figure 1: T2-weighed sagittal MRI showing a calcified T7-T8 disc compressing on the spinal cord
Mentions: So far the published articles emphasize on “intraoperative imaging after exposure and marking of a fixed anatomic structure” to prevent wrong level spine surgery,[14] but there are situations even this measure would not be enough. Here illustrates two thoracic spine surgeries which posed difficulty in determining the correct levels during the surgery. Without the help of computer-assisted image guidance, different measures are generated in order to make sure the correct levels were operated. The first case is about a patient who had a T7--T8 calcified disc fragment that compressed on the spinal cord [Figure 1]. Because the bony anatomy was normal in this case, it would be difficult to locate the disc level of T7--T8 during the surgery by using intra-operative X-ray only. Request was made to the interventional radiologist to place fiducial markers at the right T7 and T8 pedicle before the surgery, thus facilitating in identifying the correct levels during the surgery [Figure 2].

Bottom Line: The current method to prevent wrong level spine surgery performed is mainly relied on intra-operative X-ray.There are situations that even with intraoperative X-ray, correct level still cannot be reliably identified.Examples of patient whose surgery can easily be performed on the wrong level are illustrated.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Spine Center, Swedish Neuroscience Institute, 550 17 Ave., Suite 500, Seattle, WA 98122, USA.

ABSTRACT

Background: Even though a lot of effort has gone into preventing operating at the wrong site and wrong patient, wrong-level surgery is a unique problem in spine surgery.

Methods: The current method to prevent wrong level spine surgery performed is mainly relied on intra-operative X-ray. Unfortunately, because of the unique features and anatomy of the spinal column, wrong level spine surgery still happens. There are situations that even with intraoperative X-ray, correct level still cannot be reliably identified.

Results: Examples of patient whose surgery can easily be performed on the wrong level are illustrated. A protocol to prevent wrong-level spine surgery preformed is developed.

Conclusion: The consequence of wrong-level spine surgery not only generates another surgery of the intended level; it is usually also associated with lawsuit. Strictly following this protocol can prevent wrong-level spine surgery.

No MeSH data available.


Related in: MedlinePlus