A prospective evaluation of the role for intraoperative x-ray in lumbar discectomy. Predictors of incorrect level exposure

Ammerman, Joshua M.; Ammerman, Matthew D.; Dambrosia, James; Ammerman, Bruce J.

doi:10.1016/j.surneu.2006.05.069

Cited by 82 publications

(21 citation statements)

References 15 publications

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“…Prevention training of residents and fellows is of utmost importance as demonstrated by Mesfin et al [23]. Although various techniques have previously been described to help to reduce the risk of this occurrence [9,10], it is important to share new, successful techniques aimed toward decreasing the incidence of wrong level spine surgery. Surgeons should develop a standard practice and protocol to prevent wrong level surgery [24].…”

Section: Discussionmentioning

confidence: 99%

“…In particular, the presence of lumbosacral transitional vertebrae may complicate lumbar spinal procedures by making it difficult to correctly identify the proper level while in the operating theatre [6]. Effective use of intraoperative spine level localization techniques, along with careful review of preoperative imaging, allows the surgeon to correctly identify the proper spinal level even when anatomical variations are present [7][8][9]. Ebraheim et al, investigated and compared the accuracy of identifying lumbar decompression and fusion levels with the use of direct observation and palpation of the anatomic landmarks, versus intraoperative lateral radiography.…”

Section: Introductionmentioning

confidence: 99%

“…The authors studied eighty patients and concluded that direct observation and palpation was not a reliable method to localize lumbar fusion levels with only 95% accuracy [7]. Many techniques designed to prevent wrong level surgery have already been presented in the literature, as numerous authors have outlined and shared their surgical techniques designed to reduce the chance of wrong level surgery [1,5,[9][10][11][12][13][14][15][16][17][18][19]. Additionally, both the North American Spine Societies as well as the Joint Commissions on Accreditation of Healthcare Organizations have established guidelines to be followed during surgery in order to prevent wrong level procedures [20].…”

Section: Introductionmentioning

confidence: 99%

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Avoidance of Wrong Level Surgery in the Lumbar Spine: A Technical Report

Chin¹,

Pencle²,

Kubik³

et al. 2015

J Spine

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Study Background: Wrong level surgery remains one of the detrimental technical mistakes that can occur during a surgeon's career. There is a higher frequency of wrong site surgery in the lumbar spine compared to the cervical spine. The authors aim to present a localization technique designed to aid in the prevention of wrong level surgery with the use of preoperative and intraoperative localization. Methods:We prospectively followed 240 patients who underwent less exposure surgery for the lumbar spine. We identified the correct operative level using a combination of a 22-guage spinal needle placed under fluoroscopy in the lamina of the vertebra of the target intervertebral disc space prior to incision and then placing a hooked dilator between the spinous processes of the intervertebral space to provide actual confirmation within the operative space.Results: Data showed that all 240 patients had surgery performed on the correct level using the described technique and the placement of the percutaneous needle assisted in minimizing the incision size to less than 5 cm for a single level fusion in all cases. Conclusion:The described technique allows for localization prior to incision, smaller incision size, consistent and accurate localization when performing lumbar spinal surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Avoidance of Wrong Level Surgery in the Lumbar Spine: A Technical Report

Chin¹,

Pencle²,

Kubik³

et al. 2015

J Spine

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Thambiraj

Quraishi

2012

Eur Spine J

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Purpose of study To describe a simple and reliable method of intra-operative localisation of thoracic spine in a single surgical setting. Summary of background Intra-operative localisation of thoracic spine levels can be difficult due to anatomical constraints, such as scapular shadow, patient's size and poor bone quality. This is particularly true in cases of thoracic discectomies in which the vertebral bodies appear normal. There are several methods described in recent literature to address this. Many of them require a separate procedure which was performed often the previous day. We report a technique which addresses the issue of localising thoracic level intra-operatively. Materials and methods After induction of general anaesthesia, the patient was placed prone and the pedicle of interest was identified using fluoroscopy. A K-wire was then inserted percutaneously into this pedicle under image guidance [confirmed in the antero-posterior (AP) and lateral views]. The wire was then cut close to the skin after bending it. The patient was now positioned laterally and the intended procedure performed through an anterior trans-thoracic approach. The 'K' wire was removed at the end of the procedure. Results and conclusion We routinely used this technique in all our thoracic discectomies (four cases in 2 years). There were no intra-operative complications. This method is simple, avoids the patient undergoing two procedures and requires no more ability than placing an implant in the pedicle under fluoroscopy. Placing the 'K' wire into a fixed point like the pedicle facilitates rapid intra-operative viewing of the level of interest and is removed easily at the conclusion of surgery.

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“…In one series, the wrong level was approached in 15% of cases undergoing a lumbar discectomy 2 . We report three steps to avoid incorrect level surgery and litigation.…”

Section: Introductionmentioning

confidence: 92%