How to avoid wrong-level and wrong-side errors in lumbar microdiscectomy

Abstract

The problem of an incorrect level or side in lumbar surgery remains unresolved. The authors propose a useful and easily applied procedure to reduce such a risk. Larger studies comparing different methods of avoiding such errors will probably lead to the definition and wide adoption of a surgical behavior aiming to reach a near-zero error rate.

Intra-operative localisation of thoracic spine level: a simple “‘K’-wire in pedicle” technique

“…A number of techniques have been described in the literature to reduce the incidence of wrong level surgery. [2,3,[5][6][7][8][9][10][11][12][13]. Fluoroscopy has been successfully used for intraoperative localisation of cervical and lumbar spine levels by counting the bony landmarks.…”

Three ways to avoid incorrect-level lumbar spine surgery

“…In 2010 a retrospective study by Irace and Corona reported the use of a pre-incision wire marker inserted to the spinous process using radiography for patients undergoing microlumbar discectomies 3 . They described one case of incorrect approach.…”

Intraoperative Imaging for Verification of the Correct Level During Spinal Surgery

“…When performing a lumbar microdiscectomy or a one-level decompression (even endoscopically assisted), the exploration of a wrong disc space may be not considered a relevant error; nevertheless it can become a true ordeal for the patient in terms of acute or late-occurring complications [1]. Medico-legal implications are easily understood, although such a matter is ill-defined.…”

“…Second, anatomical variations (e.g., a transitional vertebra) may contribute to miss the interspace to be explored. As a final point, even an L5-S1 disc space in a hyperlordotic spine may be missed if the superficial dissection and the operative microscopy are not oriented in an oblique enough direction [1]. Therefore the basic rule to perform a microsurgical one-level operation at the correct lumbar interspace is to obtain a good-quality x-ray intraoperative confirmation; a lateral view provided by a C-arm fluoroscopic machine, well placed over the patient lying prone and with a metallic tool applied to a bony marker (e.g., the spinous process), allows the surgeon to direct the dissection toward the correct space to be explored, even if working in a tubularlike surgical corridor.…”