Intra-operative imaging for spinal level localisation in lumbar surgery

Area of Science:

• Neurosurgery
• Spinal Surgery
• Radiology in Surgery

Background:

• The Society of British Neurological Surgeons (SBNS) recommends three intra-operative X-rays for spinal localization during lumbar surgery.
• Current practice varies among surgeons regarding adherence to these imaging guidelines.
• Variations include performing one, two, or all three recommended intra-operative X-rays.

Purpose of the Study:

• To assess adherence to SBNS intra-operative imaging guidelines in lumbar surgery.
• To determine the impact of imaging adherence on surgery length.
• To investigate the effect on complication rates, specifically wrong-level surgery.

Main Methods:

• Retrospective review of 301 lumbar decompression or discectomy cases over one year.
• Analysis of surgical logbooks from three consultant neurosurgeons.
• Correlation of intra-operative imaging practices with surgical outcomes.

Main Results:

• No cases of wrong-level surgery were recorded.
• The incorrect spinal level was initially exposed in 4.3% of cases.
• Cases with initial wrong-level exposure often involved fewer than the recommended three intra-operative X-rays.

Conclusions:

• Performing the three recommended intra-operative X-rays may improve identification of wrong-level exposures.
• Adherence to imaging guidelines could potentially reduce overall surgery length.
• Standardized intra-operative imaging protocols may enhance patient safety in lumbar spine procedures.