Abstract
Spine surgery at the wrong level is an adversity that many spine surgeons will encounter in their career, and it falls under the wrong-site surgery sentinel events reporting system. The cervical spine is the second most common location in the spine at which surgery is performed at the wrong level. Anatomical variations of the cervical spine are one of the most important incriminating risk factors. These anomalies include craniocervical junction abnormalities, cervical ribs, hemivertebrae, and block/fused vertebrae. In addition, patient characteristics, such as tumors, infection, previous cervical spine surgery, obesity, and osteoporosis, play an important role in the development of cervical surgery at the wrong level. These were described, and several effective techniques to prevent this error were provided. A thorough review of the English-language literature was performed in the database PubMed between 1981 and 2019 to review and summarize these risk factors. Compulsive attention to these factors is essential to ensure patient safety. Therefore, the surgeon must carefully review the patient’s anatomy and characteristics through imaging and collaborate with radiologists to reduce the likelihood of performing cervical spine surgery at the wrong level.
Highlights
BackgroundCervical spine surgery at the wrong level is a burdensome situation both for the patient and the surgeon, as it leads to repeated operation with further risks, damages the doctor-patient relationship, and results in legal actions [1]
We present several cervical spine anatomical variations and patient characteristics that can potentially lead to surgery at the wrong level, including craniocervical junction abnormalities, cervical ribs, hemivertebra, block/fused vertebra, tumors, infection, previous cervical surgery, obesity, and osteoporosis
Peer-reviewed articles were searched through the PubMed database using the search terms “wrong level surgery”, “cervical spine anomalies”, “craniocervical junction abnormalities”, “atlantooccipital assimilation”, “basilar invagination”, “C1 anterior and posterior arch anomalies”, “os odontoideum”, “cervical rib” “cervical hemivertebra”, “Klippel-Feil syndrome”, “obesity and spine surgery”, “osteoporosis and spine surgery”, until April 1, 1981
Summary
Cervical spine surgery at the wrong level is a burdensome situation both for the patient and the surgeon, as it leads to repeated operation with further risks, damages the doctor-patient relationship, and results in legal actions [1]. It has been characterized as wrong-site surgery, and the Joint Commission on Accreditation of Healthcare Organization (JCAHO) reported that wrong-site surgery was the most common sentinel event in 2008 [1,2]. Unusual patient characteristics and anatomy are major risk factors and should be taken into consideration when performing spine surgery
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