Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Methods used by surgeons for localization of spinal level have not been well studied, and wrong level spine surgery continues despite national efforts by regulators and professional societies. Our objectives were to better understand the scope of wrong level lumbar spine surgery and current practices in place to help avoid these errors.
The Joint Section on Disorders of the Spine and Peripheral Nerves (Spine Section) developed a survey on single-level lumbar spine decompression surgery. Invitations to complete the web-based survey were sent to all Spine Section members. Respondents were assured of confidentiality.
There were 569 responses from 1,045 requests (54%). The majority of surgeons either routinely (74%) or sometimes (11%) obtain preoperative imaging for incision planning. The majority of surgeons indicated that post-incision imaging for localization is obtained either routinely prior to bone removal (73%) or most frequently prior to bone removal but occasionally after (16%). Almost 50% of reporting surgeons have performed wrong level lumbar spine surgery at least once, and more than 10% have performed wrong side lumbar spine surgery at least once. Nearly 20% of responding surgeons have been the subject of at least one malpractice case relating to these errors. Only 40% of respondents felt that the Joint Commission's site marking/"time out" protocol has led to a reduction in these errors.
There is substantial heterogeneity in approaches used to localize operative levels in the lumbar spine, and existing safety protocols may not be mitigating wrong level surgery to the extent previously thought.