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

Abstract

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.