Anatomical Variations That Can Lead to Spine Surgery at the Wrong Level: Part III Lumbosacral Spine

Shah, Manan; Halalmeh, Dia R.; Sandio, Aubin; Tubbs, R. Shane; Moisi, Marc

doi:10.7759/cureus.9433

Cited by 20 publications

(28 citation statements)

References 37 publications

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“…Universal Protocol-JCAHO (Joint Commission on Accreditation of Healthcare Organizations), Time Outs, and the 3R's) are aimed at avoiding WLS, WSS, and WSSS [Table 1]. [1,[2][3][4][5][6][7][8][9][10]12,14,[16][17][18][19][20] Clarke et al (2008) used the 3 step R protocol (i.e. right patient, right side, and right level), Time Outs, and marking the correct site to avoid WSSS.…”

Section: Use Of the Universal Protocol Time Outs And The 3 R's To Avoid Wrong Level Surgery (Wls) Wrong Side Surgery (Wss) And Wrong Sitementioning

confidence: 99%

“…includes wrong site surgery (WSS) as well). [1,2,[4][5][6][7][8][9][10]13,14,16,18,19,20] Although routine use of the Universal Protocol, Time-Outs, and the 3 R's (i.e. right patient, right procedure, right location/side) should largely limit/eliminate the first two "errors, " WLS and WSS still occur with an unacceptable frequency.…”

Section: Introductionmentioning

confidence: 99%

“…right patient, right procedure, right location/side) should largely limit/eliminate the first two "errors, " WLS and WSS still occur with an unacceptable frequency. [1,2,[4][5][6][7]10,12,14,[16][17][18][19][20] Here, we reviewed the incidence of WLS and WSS in 20 studies, and looked at the major factors contributing to these "errors;" spinal anomalies/anatomic variants, and failure to obtain adequate intraoperative X-rays/Fluoroscopic images (i.e. inadequate number, inadequate quality, poor/misinterpretation of X-rays/fluoroscopic images).…”

Section: Introductionmentioning

confidence: 99%

“…failure to "speak up"), fatigue, rushing/ emergent procedures, and others). [1,2,[4][5][6][7]10,12,14,[16][17][18][19][20] Our aim in highlighting the main failures contributing to WLS/WSS/WSSS should help limit/eliminate them in the future.…”

Section: Introductionmentioning

confidence: 99%

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A perspective on wrong level, wrong side, and wrong site spine surgery

Epstein¹

2021

Surgical Neurology International

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Background: Four of the most common “errors” in spine surgery include: operating on the wrong patient, doing the wrong procedure, performing wrong-level surgery (WLS), and/or performing wrong-sided surgery (WSS). Although preoperative verification protocols (i.e. Universal Protocol, routine Time-Outs, and using the 3 R’s (i.e. right patient, right procedure, right level/side)) have largely limited the first two “errors,” WLS and WSS still occur with an unacceptably high frequency. Methods: In 20 studies, we identified the predominant factors contributing to WLS/WSS; unusual/anatomical anomalies/variants (i.e. sacralized lumbar vertebrae. lumbarized sacral vertebra, Klippel-Feil vertebrae, block vertebrae, butterfly vertebrae, obesity/morbid obesity), inadequate/poor interpretation of X-rays/fluoroscopic intraoperative images, and failure to follow different verification protocols. Results: “Human error” was another major risk factor contributing to the failure to operate at the correct level/side (WLS/WSS). Factors comprising “human error” included; surgeon/staff fatigue, rushing, emergency circumstances, lack of communication, hierarchical behavior in the operating room, and failure to “speak up”. Conclusion: Utilizing the Universal Protocol, routine Time Outs, and the 3 R’s largelly avoid operating on the wrong spine patient, and performing the wrong procedure. However, these guidelines have not yet sufficiently reduced the frequently of WLS and WSS. Greater recognition of the potential pitfalls contributing to WLS/WSS as reviewed in this perspective should better equip spine surgeons to avert/limit such “errors” in the future.

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Section: Use Of the Universal Protocol Time Outs And The 3 R's To Avoid Wrong Level Surgery (Wls) Wrong Side Surgery (Wss) And Wrong Sitementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A perspective on wrong level, wrong side, and wrong site spine surgery

Epstein¹

2021

Surgical Neurology International

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“…Studies of the vertebral column morphology considering numerical variations and prevalence of CVA are reported with increasing frequency in human and veterinary medicine [18,[22][23][24][25]. Retrospective analysis of radiographs provides relevant data for non-invasive, ethically acceptable determination of prevalence of different vertebral formulae and naturally occurring CVA.…”

Section: Discussionmentioning

confidence: 99%

Vertebral Formulae and Congenital Vertebral Anomalies in Guinea Pigs: A Retrospective Radiographic Study

Proks

Johansen

Nývltová

et al. 2021

Animals

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The objectives of this retrospective study of 240 guinea pigs (148 females and 92 males) were to determine the prevalence of different vertebral formulae and the type and anatomical localization of congenital vertebral anomalies (CVA). Radiographs of the cervical (C), thoracic (Th), lumbar (L), sacral (S), and caudal (Cd) part of the vertebral column were reviewed. Morphology and number of vertebrae in each segment of the vertebral column and type and localization of CVA were recorded. In 210/240 guinea pigs (87.50%) with normal vertebral morphology, nine vertebral formulae were found with constant number of C but variable number of Th, L, and S vertebrae: C7/Th13/L6/S4/Cd5-7 (75%), C7/Th13/L6/S3/Cd6-7 (4.17%), C7/Th13/L5/S4/Cd6-7 (2.50%), C7/Th13/L6/S5/Cd5-6 (1.67%), C7/Th12/L6/S4/Cd6 (1.25%), C7/Th13/L7/S4/Cd6 (1.25%), C7/Th13/L7/S3/Cd6-7 (0.83%), C7/Th12/L7/S4/Cd5 (0.42%), C7/Th13/L5/S5/Cd7 (0.42%). CVA were found in 30/240 (12.5%) of guinea pigs, mostly as a transitional vertebra (28/30), which represents 100% of single CVA localised in cervicothoracic (n = 1), thoracolumbar (n = 22) and lumbosacral segments (n = 5). Five morphological variants of thoracolumbar transitional vertebrae (TTV) were identified. Two (2/30) guinea pigs had a combination of CVA: cervical block vertebra and TTV (n = 1) and TTV and lumbosacral transitional vertebra (LTV) (n = 1). These findings suggest that guinea pigs’ vertebral column displays more morphological variants with occasional CVA predominantly transitional vertebrae.

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Definition of Normal Vertebral Morphometry Using NHANES‐II Radiographs

Hipp¹,

Grieco²,

Newman³

et al. 2022

JBMR Plus

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A robust definition of normal vertebral morphometry is required to confidently identify abnormalities such as fractures. The Second National Health and Nutrition Examination Survey (NHANES-II) collected a nationwide probability sample to document the health status of the United States. Over 10,000 lateral cervical spine and 7,000 lateral lumbar spine X-rays were collected. Demographic, anthropometric, health, and medical history data were also collected. The coordinates of the vertebral body corners were obtained for each lumbar and cervical vertebra using previously validated, automated technology consisting of a pipeline of neural networks and coded logic. These landmarks were used to calculate six vertebral body morphometry metrics. Descriptive statistics were generated and used to identify and trim outliers from the data. Descriptive statistics were tabulated using the trimmed data for use in quantifying deviation from average for each metric. The dependency of these metrics on sex, age, race, nation of origin, height, weight, and body mass index (BMI) was also assessed. There was low variation in vertebral morphometry after accounting for vertebrae (eg, L1, L2), and the R 2 was high for ANOVAs. Excluding outliers, age, sex, race, nation of origin, height, weight, and BMI were statistically significant for most of the variables, though the F-statistic was very small compared to that for vertebral level. Excluding all variables except vertebra changed the ANOVA R 2 very little. Reference data were generated that could be used to produce standardized metrics in units of SD from mean. This allows for easy identification of abnormalities resulting from vertebral fractures, atypical vertebral body morphometries, and other congenital or degenerative conditions. Standardized metrics also remove the effect of vertebral level, facilitating easy interpretation and enabling data for all vertebrae to be pooled in research studies.

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Anatomical Variations That Can Lead to Spine Surgery at the Wrong Level: Part III Lumbosacral Spine

Cited by 20 publications

References 37 publications

A perspective on wrong level, wrong side, and wrong site spine surgery

A perspective on wrong level, wrong side, and wrong site spine surgery

Vertebral Formulae and Congenital Vertebral Anomalies in Guinea Pigs: A Retrospective Radiographic Study

Definition of Normal Vertebral Morphometry Using NHANES‐II Radiographs

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