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A perspective on wrong level, wrong side, and wrong site spine surgery.

Nancy Epstein1

  • 1Clinical Professor of Neurological Surgery, , School of Medicine, State University of New York at Stony Brook, and c/o Dr. Marc Agulnick, 1122 Franklin Avenue Suit 106, Garden City, NY 11530, United States.

Surgical Neurology International
|July 5, 2021
PubMed
Summary

Wrong-level surgery (WLS) and wrong-sided surgery (WSS) remain common in spine procedures. Recognizing anatomical variations and human factors is crucial for preventing these errors.

Keywords:
Avoid Wrong Level (WLS)/Wrong Side Spine Surgery (WSS)Lumbar surgeryMultiple intraoperative X-ray/fluoroscopy techniquesRight (Correct) sideRight levelRight patientRight procedureUniversal Protocols

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Area of Science:

  • Neurosurgery
  • Orthopedic Surgery
  • Patient Safety

Background:

  • Common surgical errors include wrong patient, wrong procedure, wrong-level surgery (WLS), and wrong-sided surgery (WSS).
  • Preoperative verification protocols have reduced wrong patient and procedure errors.
  • WLS and WSS persist at high rates despite existing protocols.

Purpose of the Study:

  • To identify predominant factors contributing to WLS and WSS in spine surgery.
  • To highlight the role of human error and anatomical variations in surgical errors.
  • To inform strategies for reducing WLS and WSS.

Main Methods:

  • Systematic review of 20 studies.
  • Analysis of factors contributing to WLS/WSS.
  • Categorization of error-related factors.

Main Results:

  • Anatomical anomalies (e.g., sacralized vertebrae, obesity) and poor image interpretation are key contributors to WLS/WSS.
  • "Human error" factors include fatigue, rushing, poor communication, and hierarchical dynamics.
  • Failure to adhere to verification protocols exacerbates WLS/WSS risk.

Conclusions:

  • Current protocols effectively prevent wrong patient/procedure errors but not WLS/WSS.
  • Enhanced awareness of WLS/WSS pitfalls is necessary for spine surgeons.
  • Further strategies are needed to minimize WLS and WSS in spine surgery.