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Ramesh Sahjpaul

prevent wrong-site surgery but it will help to prevent wrong-sided surgery. In addition, routine use of intraoperative imaging guidance, where applicable, essentially eliminates wrong-site craniotomy. Whereas the authors correctly observe that external spinal landmarks do not readily identify surgical levels, we have found it useful to mark the planned level and side to the best approximation as this provides yet another checkpoint to reduce the risk of wrong-level and wrong-sided surgery. We have adopted an additional “concluding time-out” component that occurs at the

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Claudio Irace, Luigi Giannachi, Susanna Usai and Claudio Corona

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Joshua M. Ammerman and Matthew D. Ammerman

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Claudio Irace and Claudio Corona

, Giannachi L , Usai S , Corona C : Wrong-sided surgery . J Neurosurg Spine 9 : 107 – 108 , 2008 . (Letter) 10 Jhawar BS , Mitsis D , Duggal N : Wrong-sided and wrong-level neurosurgery: a national survey . J Neurosurg Spine 7 : 467 – 472 , 2007 11 Joint Commission on the Accreditation of Healthcare Organizations (USA) : 2004 Universal Protocol ( ) [Accessed February 2, 2010] 12 Krämer J : Micro- or macrodiscotomy for open lumbar disc surgery? . Eur

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Balraj S. Jhawar, Demytra Mitsis and Neil Duggal


Perhaps the single greatest error that a surgeon hopes to avoid is operating at the wrong site. In this report, the authors describe the incidence and possible determinants of incorrect-site surgery (ICSS) among neurosurgeons.


The authors asked neurosurgeons to complete an anonymous survey. These surgeons were asked to report the number of craniotomies and lumbar and cervical discectomies performed during the previous year, as well as whether ICSS had occurred. They were also asked detailed questions regarding the potential determinants of ICSS.


There was a 75% response rate and a 68% survey completion rate. Participating neurosurgeons performed 4695 lumbar and 2649 cervical discectomies, as well as 10,203 craniotomies. Based on this self-reporting, the incidence of wrong-level lumbar surgery was estimated to be 4.5 occurrences per 10,000 operations. The ICSSs per 10,000 cervical discectomies and craniotomies were 6.8 and 2.2, respectively. Neurosurgeons recognized fatigue, unusual time pressure, and emergent operations as factors contributing to ICSS. For spine surgery, in particular, unusual patient anatomy and a failure to verify the operative site by radiography were also commonly reported contributors.


Neurosurgical ICSSs do occur, but are rare events. Although there are significant limitations to the survey-based methodology, the data suggest that the prevention of such errors will require neurosurgeons to recognize risk factors and increase the use of intraoperative imaging.

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Matthew J. Tormenti, Matthew B. Maserati, Christopher M. Bonfield, Peter C. Gerszten, John J. Moossy, Adam S. Kanter, Richard M. Spiro and David O. Okonkwo

sequelae. Wrong-Level Surgery The reported incidence of wrong-level surgery in the lumbar spine ranges from 0.03% to 0.04%. 1 , 21 Although adherence to the preoperative timeout process, review of relevant radiographs, and intraoperative localization have helped decrease rates of wrong-level and wrong-side surgery, wrong-level surgery is not preventable in all cases. One patient (0.2%) in our series underwent laminectomy and partial medial facetectomy at an unintended level before the improper localization was realized; TLIF was performed as planned at the level