Abstract
Spine surgery at the wrong level is a detrimental ordeal for both surgeon and patient, and it falls under the wrong-site surgery sentinel events reporting system. While there are several methods designed to limit the incidence of these events, they continue to occur and can result in significant morbidity for the patient and malpractice lawsuits for the surgeon. In thoracic spine, numerous risk factors influence the development of this misadventure. These include anatomical variations such as transitional vertebrae, rib variants, hemivertebra, and block/fused vertebrae as well as patient characteristics, such as tumors, infections, previous thoracic spine surgery, obesity, and osteoporosis. An extensive literature search of the PubMed database up to 2019 was completed on each of the anatomical entities and their influence on developing thoracic spine surgery at the wrong level, taking into consideration patient’s individual factors. A reliable protocol and effective techniques were described to prevent this error. In addition, the surgeon should collaborate with radiologists, particularly in challenging cases. A thorough understanding of the surgical anatomy and its variants coupled with patients characteristic is crucial for maximal patient benefit and avoidance of thoracic spine surgery at the wrong level.
Highlights
BackgroundSpine surgery at the wrong level has tremendous clinical and emotional implications for the patient and surgeon
We describe several of the thoracic spine anatomical variations such as thoracolumbar transitional vertebrae, rib variants, hemivertebra, and block/fused vertebrae, and patient characteristics including tumors, infection, previous thoracic surgery, obesity, and osteoporosis that might result in greater risk of surgery at the wrong level
We summarize the potential thoracic anatomical variations and patients characteristics that can lead to thoracic spine surgery at the wrong level as follows: Transitional Vertebrae
Summary
Spine surgery at the wrong level has tremendous clinical and emotional implications for the patient and surgeon. It can lead to additional procedures and risks, damage the doctor-patient relationship, and usually associated with legal actions [1]. It is part of the wider field of wrong-site surgery [1,2]. Out of 415 spine surgeons, 207 (approximately 50%) reported that they had performed at least one such surgery in their career [3]. In a questionnaire study encompassing 1,300,000 spine surgeries, 418 procedures had been performed at the wrong level, with 8% performed on the thoracic region, whereas 71% were performed on the lumbar and 21% on the cervical regions [1]. Because of its complex anatomy and higher number of vertebrae, surgery at the wrong level in the thoracic spine continues to occur
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
