The Scope and Impact of Wrong-Level Lumbar Spine Surgery: A Survey of the Joint Section on Disorders of the Spine and Peripheral Nerves

Keywords: spine surgery, technique, complications, outcome, survey

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     Wrong-level spine surgery continues despite efforts by regulators and professional societies.
     The authors surveyed the membership of the Joint Section of Spinal Disorders and Peripheral Nerve Diseases (Spine Section) to better understand wrong-level lumbar spine surgery.
     The Spine Section developed a survey on wrong-level lumbar spine decompression surgery. Invitations to complete the web-based survey were sent to all members of the Spine Section. Respondents were assured of confidentiality.
     There were 569 responses from 1,045 requests (54%). 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 medical malpractice case relating to these errors. In 68% of wrong-level or wrong-side surgery cases, the error was discovered at the time of surgery, and the surgeon proceeded with the correct level/side. The error was discovered immediately following the procedure in 5% of cases and sometime <24 hours after the procedure in 27% of cases. Almost 90% of surgeons reported at least one close call, including wrong-level exposure but no bony removal (65%), wrong-side exposure but no bony removal (3%), or both (20%).
     This is a retrospective study.
     Existing safety protocols may not be preventing wrong-level spine surgery to the extent previously thought.
     These findings argue for additional study of wrong-level spine surgery, including development of a standardized approach for level confirmation that can be used for a multi-institutional effort to further investigate these errors.


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