Wrong-level spinal surgery : a multicentre analysis of 34,544 consecutive cases

Area of Science:

• Neurosurgery
• Spine Surgery
• Patient Safety

Background:

• Wrong-level spinal surgery (WLSS) is a significant patient safety concern.
• Previous studies on WLSS incidence and causes are limited by small sample sizes and methodology.
• Accurate data on WLSS incidence, risk factors, and characteristics are crucial for prevention.

Purpose of the Study:

• To accurately determine the incidence of WLSS across different spinal regions.
• To identify high-risk situations and causative mechanisms of WLSS.
• To analyze event characteristics, including recognition, correction, and patient-surgeon conflicts.

Main Methods:

• Retrospective analysis of a prospectively collected multicentre registry.
• Inclusion of 34,544 consecutive patients undergoing spinal surgery between 2012 and 2022.
• Detailed investigation of WLSS cases for level identification, causes, timing, and conflicts.

Main Results:

• Overall WLSS incidence was 0.12%, with significant regional variations (thoracic 0.42%, lumbar 0.13%, cervical 0.05%).
• Extracanal disc herniation in lumbar procedures showed a higher risk (3.41%) compared to intracanal herniation (0.16%).
• Intraoperative disorientation (81.3%) was the primary cause, especially at L4/5 or L5/S1 levels; 84.4% of errors were recognized before extubation.

Conclusions:

• WLSS incidence varies significantly by spinal region, with thoracic surgery and extracanal disc herniation presenting the highest risks.
• Intraoperative disorientation is the main cause, particularly in lower lumbar levels.
• Patient-surgeon conflicts can still occur even when errors are promptly recognized and corrected.