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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 tumor involvement at the vertebral bodies of T3 and T4
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Figure 3: T2-weighed sagittal MRI showing tumor involvement at the vertebral bodies of T3 and T4

Mentions: The second case is more difficult because the lesion is located at the T3 and T4 level. Intraoperative x-ray localization at these levels is very difficult because the patient's shoulders obstruct the view. In this case even though the MRI shows gross abnormality in the vertebral body of T3 and T4 [Figure 3], the intra-operative X-ray shows no bony abnormality in the vertebral body [Figure 4]. Fiducial markers were not placed before the surgery, and computer-assisted image guidance was not available. Under this type of situation, an attending radiologist was requested to come into the operating room to assist in identifying the levels of T3 and T4. After numerous attempts by the radiologist at different angles of imaging and with different radiation intensity, the correct levels were able to be confirmed so that the correct surgery could be performed [Figure 5].


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

Hsiang J - Surg Neurol Int (2011)

T2-weighed sagittal MRI showing tumor involvement at the vertebral bodies of T3 and T4
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: T2-weighed sagittal MRI showing tumor involvement at the vertebral bodies of T3 and T4
Mentions: The second case is more difficult because the lesion is located at the T3 and T4 level. Intraoperative x-ray localization at these levels is very difficult because the patient's shoulders obstruct the view. In this case even though the MRI shows gross abnormality in the vertebral body of T3 and T4 [Figure 3], the intra-operative X-ray shows no bony abnormality in the vertebral body [Figure 4]. Fiducial markers were not placed before the surgery, and computer-assisted image guidance was not available. Under this type of situation, an attending radiologist was requested to come into the operating room to assist in identifying the levels of T3 and T4. After numerous attempts by the radiologist at different angles of imaging and with different radiation intensity, the correct levels were able to be confirmed so that the correct surgery could be performed [Figure 5].

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