title: A survey-based study of wrong-level lumbar spine surgery: the scope of the problem and current practices in place to help avoid these errors.
abstract: OBJECTIVE
  To understand better the scope of wrong-level lumbar spine surgery and current practices in place to help avoid such errors.
  
  
  METHODS
  The Joint Section on Disorders of the Spine and Peripheral Nerves (Spine Section) developed a survey on single-level lumbar spine decompression surgery. Invitations to complete the Web-based survey were sent to all Spine Section members. Respondents were assured of confidentiality.
  
  
  RESULTS
  There were 569 responses from 1045 requests (54%). Most surgeons either routinely (74%) or sometimes (11%) obtain preoperative imaging for incision planning. Most surgeons indicated that they obtained imaging after the incision was performed for localization either routinely before bone removal (73%) or most frequently before bone removal but occasionally after (16%). Almost 50% of reporting surgeons have performed wrong-level lumbar spine surgery at least once, and >10% have performed wrong-side lumbar spine surgery at least once. Nearly 20% of responding surgeons have been the subject of at least one malpractice case relating to these errors. Only 40% of respondents believed that the site marking/"time out" protocol of The Joint Commission on the Accreditation of Healthcare Organizations has led to a reduction in these errors.
  
  
  CONCLUSIONS
  There is substantial heterogeneity in approaches used to localize operative levels in the lumbar spine. Existing safety protocols may not be mitigating wrong-level surgery to the extent previously thought.
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Groff
authors.forename: Joshua E
authors.initials: JE
authors.lastname: Heller
authors.forename: Eric A
authors.initials: EA
authors.lastname: Potts
authors.forename: Praveen V
authors.initials: PV
authors.lastname: Mummaneni
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
mesh_terms: D019299:Decompression, Surgical; D017586:Diskectomy; D005471:Fluoroscopy; D019538:Health Care Surveys; D006801:Humans; D007430:Intraoperative Care; D008161:Lumbosacral Region / Q000601:surgery*; D008318:Malpractice; D019300:Medical Errors / Q000517:prevention & control* / Q000706:statistics & numerical data*; D019635:Neurosurgical Procedures; D019637:Orthopedic Procedures; D013122:Spinal Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging; D013131:Spine / Q000473:pathology / Q000601:surgery*; D014481:United States / Q000453:epidemiology