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Building Consensus: Development of Best Practice Guidelines on Wrong Level Surgery in Spinal Deformity.

Michael Vitale1, Anas Minkara1, Hiroko Matsumoto1

  • 1Columbia University Medical Center, 3959 Broadway, 8 North, New York, NY 10032, USA.

Spine Deformity
|February 8, 2018
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Summary

This study developed best practice guidelines to prevent wrong-level spinal surgery. The consensus-based guidelines include 17 interventions to improve patient safety and surgical accuracy.

Keywords:
Best practice guidelinesDelphi processSpinal deformityWrong level surgery

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Area of Science:

  • Spine Surgery
  • Surgical Safety
  • Consensus Building

Background:

  • Wrong-level spinal surgery occurs frequently, with over half of spine surgeons reporting experience with this issue.
  • Despite the high incidence, formal guidelines to prevent wrong-level spinal deformity surgery are lacking.

Purpose of the Study:

  • To establish best practice guidelines for preventing wrong-level spinal deformity surgery.
  • To achieve consensus among experienced spinal deformity surgeons on best practices.

Main Methods:

  • The Delphi process and nominal group technique were employed to achieve consensus among 16 fellowship-trained spine surgeons.
  • Three iterative rounds of anonymous voting and detailed discussion of near-consensus items were conducted.
  • Consensus was defined as 80% or higher agreement on interventions.

Main Results:

  • Consensus was reached on 17 interventions to form best practice guidelines (BPGs) for preventing wrong-level surgery.
  • A final checklist encompassing preoperative and intraoperative methods, including standardized vertebral-level counting and imaging criteria, received 100% participant support.
  • Participants had extensive experience, averaging 13.4 years in practice and performing over 100 spinal deformity surgeries annually.

Conclusions:

  • Consensus-based best practice guidelines were successfully developed to prevent wrong-vertebral-level surgery.
  • These guidelines can minimize variability in surgical practices and inform future research on intervention effectiveness.
  • The developed guidelines offer a valuable tool for enhancing patient safety in spinal deformity surgery.