The prevalence of wrong level surgery among spine surgeons

Study Design. A questionnaire study. Objective. To evaluate the prevalence of wrong level surgery among spine surgeons and their use of preventive measures to avoid its occurrence. Summary of Background Data. Wrong site surgery fails to improve the patient's symptoms and has medical, emotional, social, and legal implications. Organizations such as the North American Spine Society and the Joint Commission on Accreditation of Healthcare Organizations have established guidelines to prevent wrong site surgery. Spine surgeons' compliance with these guidelines and the prevalence of wrong-level spine surgery have not been investigated previously. Methods. All members of the American Academy of Neurologic Surgeons (n = 3505) were sent an anonymous, 30-question survey with a self-addressed stamped envelope. Results. A total of 415 (12%) surgeons responded. Sixty-four surgeons (15%) reported that, at least once, they had prepared the incorrect spine level, but noticed the mistake before making the incision. Two hundred seven (50%) reported that they had done 1 or more wrong level surgeries during their career. From an estimated 1,300,000 spine procedures, 418 wrong level spine operations had been performed, with a prevalence of 1 in 3110 procedures. The majority of the incorrect level procedures were performed on the lumbar region (71%), followed by the cervical (21%), and the thoracic (8%) regions. One wrong level surgery led to permanent disability, and 73 cases resulted in legal action or monetary settlement to the patient (17%). Conclusion. There is a high prevalence of wrong level surgery among spine surgeons; 1 of every 2 spine surgeons may perform a wrong level surgery during his or her career. Although all spine surgeons surveyed report using at least 1 preventive action, the following measures are highly recommended but inconsistently adopted: direct preoperative communication with the patient by the surgeon, marking of the intended site, and the use of intraoperative verification radiograph.