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Preventing Wrong-Level Spine Surgery.

James Paul Agolia1, Scott Robertson2, Keki Turel3

  • 1Harvard Medical School, Boston, MA, USA.

Acta Neurochirurgica. Supplement
|November 21, 2024
PubMed
Summary
This summary is machine-generated.

Wrong-level spine surgery (WLSS) remains a concern despite preventive measures. Implementing tailored protocols, like the time-out for level localization (TOLL), can help make WLSS a true never event in spine surgery.

Keywords:
Level errorLocalizationWrong-level spine surgeryWrong-site spine surgeryWrong-site surgery

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Area of Science:

  • Spine surgery
  • Patient safety
  • Medical error prevention

Background:

  • Wrong-level spine surgery (WLSS) is a serious medical error, classified as a "never event," yet it persists.
  • Preventive measures like the Universal Protocol have not eradicated WLSS, which carries severe physical and medicolegal consequences for patients and surgeons.
  • While incidence rates are generally below 1%, the high volume of spine surgeries makes this a significant concern.

Purpose of the Study:

  • To review risk factors and prevention strategies for wrong-level spine surgery (WLSS).
  • To emphasize the importance of specific protocols for spine surgery to prevent WLSS.
  • To advocate for the adoption of tailored prevention measures to eliminate WLSS.

Main Methods:

  • Categorization of WLSS risk factors into patient, imaging, and technical domains.
  • Review of existing WLSS prevention techniques, including preoperative marking and intraoperative imaging.
  • Assessment of the quality of evidence for current prevention methods, highlighting the need for prospective studies.

Main Results:

  • Risk factors for WLSS are multifactorial, involving patient-specific issues, imaging limitations, and technical challenges.
  • Intraoperative imaging is insufficient alone, as errors can occur post-imaging.
  • Current evidence for prevention methods is of low quality, indicating a need for further research.

Conclusions:

  • Professional societies advocate for universal implementation of WLSS prevention protocols by all spine surgeons.
  • A specific "time-out for level localization" (TOLL) is highlighted as a crucial element for safer surgery.
  • Tailored prevention strategies can potentially elevate WLSS to a true "never event" in spine surgery.