Abstract
Study Background: Wrong level surgery remains one of the detrimental technical mistakes that can occur during a surgeon’s career. There is a higher frequency of wrong site surgery in the lumbar spine compared to the cervical spine. The authors aim to present a localization technique designed to aid in the prevention of wrong level surgery with the use of preoperative and intraoperative localization. Methods: We prospectively followed 240 patients who underwent less exposure surgery for the lumbar spine. We identified the correct operative level using a combination of a 22-guage spinal needle placed under fluoroscopy in the lamina of the vertebra of the target intervertebral disc space prior to incision and then placing a hooked dilator between the spinous processes of the intervertebral space to provide actual confirmation within the operative space. Results: Data showed that all 240 patients had surgery performed on the correct level using the described technique and the placement of the percutaneous needle assisted in minimizing the incision size to less than 5 cm for a single level fusion in all cases. Conclusion: The described technique allows for localization prior to incision, smaller incision size, consistent and accurate localization when performing lumbar spinal surgery.
Highlights
Wrong level spinal surgery is one of the more detrimental surgical mistakes that can be made during a surgeon’s career
The incidence is low, with rates reported in the literature ranging from 0.09 to 4.5 per 10,000 surgeries performed, it is estimated that 50% of spine surgeons will perform one wrong level procedure in their career [3,5]
Many techniques designed to prevent wrong level surgery have already been presented in the literature, as numerous authors have outlined and shared their surgical techniques designed to reduce the chance of wrong level surgery [1,5,9,10,11,12,13,14,15,16,17,18,19]
Summary
Wrong level spinal surgery is one of the more detrimental surgical mistakes that can be made during a surgeon’s career. A thorough search of the literature revealed no reports that utilized our localization technique of using a spinal needle fixed in the lamina of the vertebra above the target disc space, followed by insertion of a dilator prior to decompression. It has already been demonstrated in a previous study, which this technique proved successful in localization for three patients undergoing spinal surgery in the thoracic spine [21]. We present our technique that has been shown to be accurate in correctly identifying the target spinal level in 240 lumbar procedures
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