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Michael J. Strong, Julianne Santarosa, Timothy P. Sullivan, Noojan Kazemi, Jacob R. Joseph, Osama N. Kashlan, Mark E. Oppenlander, Nicholas J. Szerlip, Paul Park, and Clay M. Elswick

A ccurate localization in the thoracic spine remains a significant challenge in surgery. Sixty-eight percent of spine surgeons surveyed have admitted to wrong-level localization, although some of the wrong-level exposures were rectified intraoperatively. 1 Furthermore, approximately 1 of every 2 spine surgeons has performed a wrong-level surgery. 2 Wrong-level surgery falls under the broader term “wrong-site surgery” and is considered a sentinel event that exposes the patient to additional risks and unnecessary procedures, harms the doctor

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Peyman Pakzaban

. Implications for Wrong-Level Surgery In this study, the location of the skin incision guided by the localizer was consistently found to overlie the target segment in all cases, providing an optimal trajectory for the surgical approach without the need to modify the incision or the surgical trajectory. This was true even for very small incisions or for very large patients. In a recent survey of Canadian neurosurgeons, the incidence of wrong-level lumbar spine surgery was found to be 4.5 occurrences per 10,000 operations. Inadequacy of the intraoperative radiography images

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Claudio Irace and Claudio Corona

RDHs. These operations were excluded from the study but served as confirmation of the correctness of the surgically treated level. The follow-up ranged from 1 to 96 months, starting 1 month after the first studied procedure and finishing ~ 8 years after it. Results Thirty-one patients were lost to follow-up. All patients in the remaining cases were visited on an outpatient basis, and 201 of them underwent follow-up CT or MR imaging studies. No evidence of wrong-level surgery was found ( Fig. 3 ), and no clinically apparent level or side errors were registered

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Cheerag D. Upadhyaya, Jau-Ching Wu, Cynthia T. Chin, Gopalakrishnan Balamurali, and Praveen V. Mummaneni

T he intraoperative localization of thoracic vertebral levels remains a challenging problem. A recent questionnaire study by Mody et al. 12 found a high prevalence of wrong-level surgeries among spine surgeons with nearly 50% of surgeons performing a wrong-level surgery during their career. Correct-level spine surgery is an important patient safety and quality-of-care issue. 5 Several factors make the thoracic spine especially difficult for proper target level localization including osteoporosis, obesity, scapular/humoral shadow, anatomical variations in

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Richard Bransford, Fangyi Zhang, Carlo Bellabarba, Mark Konodi, and Jens R. Chapman

to be intradural, a clear indication for anterior transthoracic decompression. For this condition, a transthoracic approach will permit ventral dural access and direct repair of the defect. 9 , 10 While transthoracic procedures have become common in many surgical subspecialties, potential complications and morbidity are not trivial and include cardiopulmonary death, 26 pneumonia, 12 paralysis, 12 dural tear, 7 , 12 wrong-level surgery, pulmonary embolism, 7 incisional hernia, atelectasis requiring pulmonary support, 8 intercostal neuralgia, 9 the potential

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shed insight into nerve-related growth. Neurosurg Focus Neurosurgical Focus FOC 1092-0684 American Association of Neurological Surgeons 2014.3.FOC-DSPNABSTRACTS Abstract Outcomes Award 228. Wrong Level Surgery in the Thoracic Spine: A Survey Based Evaluation Eric A. Potts , MD , Justin S. Smith , MD PhD , Christopher I. Shaffrey , MD FACS , Praveen V. Mummaneni , MD , Michael W. Groff , MD FACS , and Joseph S. Cheng , MD MS University of Virginia Health System

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are significantly inferior to traditional PS (p<0.03). Neurosurg Focus Neurosurgical Focus FOC 1092-0684 American Association of Neurological Surgeons 2013.1.FOC-LSRSABSTRACTS Poster Abstract Poster 7. Analysis of the Techniques for Thoracic and Lumbar Level Localization During Posterior Spine Surgery and the Occurrence of Wrong Level Surgery: Results from a National Survey Jillian E. Mayer , BA , Rajan P. Dang , BA , Guillermo D. Prieto , MD , Samuel K. Cho , MD , Sheeraz A

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, and Daniel K. Resnick , MD (University of Wisconsin-School of Medicine) 3 2013 34 3 Cranial Nerve Surgery A14 A14 Copyright held by the American Association of Neurological Surgeons. You may not sell, republish, or systematically distribute any published materials without written permission from JNSPG. 2013 Introduction: For spine surgeons, wrong level surgery remains a significant concern. In the case of one of the most frequently performed procedures, the lumbar microdiscectomy, anatomical exposure is minimal, and

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Zachary A. Medress, Michael C. Jin, Austin Feng, Kunal Varshneya, and Anand Veeravagu

advanced imaging in patients presenting with acute-onset back pain. 18 Furthermore, plain-film radiographs may miss a subset of spinal cord injury cases with structural anomalies detectable only by MRI. 19 Wrong-Level Surgery Wrong-site surgeries are surgical procedures performed on the wrong patient or side. Designated as sentinel events by the Joint Commission on Accreditation of Healthcare Organizations (JC), they have been the second most commonly reported event from 1995 to 2005, involving 455 (12.8%) of 3548 events. 20 With regard to spine surgery, wrong-level

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Mendel Castle-Kirszbaum, Julian Maingard, Tony Goldschlager, and Ronil V. Chandra

a single radiograph is required to guide the incision. On exposure of the spine, the coil may be directly visualized, giving immediate level confirmation, or if required, a second, single radiograph can be obtained. A single prospective case series of 100 discectomies found no instances of wrong-site surgery, but in 15% of cases the wrong level was initially exposed. 1 Surveys of spine surgeons have demonstrated that between 33.1% and 54.5% will perform at least one case of wrong-level surgery in their career ( Table 1 ). 6 , 8 , 10 , 11 These results are