title: Errors of level in spinal surgery: an evidence-based systematic review.
abstract: Wrong-level surgery is a unique pitfall in spinal   surgery and is part of the wider field of wrong-site surgery. Wrong-site   surgery affects both patients and surgeons and has received much   media attention. We performed this systematic review to determine   the incidence and prevalence of wrong-level procedures in spinal   surgery and to identify effective prevention strategies. We retrieved   12 studies reporting the incidence or prevalence of wrong-site surgery   and that provided information about prevention strategies. Of these,   ten studies were performed on patients undergoing lumbar spine surgery   and two on patients undergoing lumbar, thoracic or cervical spine procedures.   A higher frequency of wrong-level surgery in lumbar procedures than   in cervical procedures was found. Only one study assessed preventative   strategies for wrong-site surgery, demonstrating that current site-verification protocols   did not prevent about one-third of the cases. The current literature   does not provide a definitive estimate of the occurrence of wrong-site   spinal surgery, and there is no published evidence to support the   effectiveness of site-verification protocols. Further prevention   strategies need to be developed to reduce the risk of wrong-site surgery.
authors.affiliation: Centre for Sport and Exercise Medicine, London, UK.
authors.forename: U G
authors.initials: UG
authors.lastname: Longo
authors.forename: M
authors.initials: M
authors.lastname: Loppini
authors.forename: G
authors.initials: G
authors.lastname: Romeo
authors.forename: N
authors.initials: N
authors.lastname: Maffulli
authors.forename: V
authors.initials: V
authors.lastname: Denaro
mesh_terms: D019317:Evidence-Based Medicine; D006801:Humans; D015994:Incidence; D019300:Medical Errors / Q000517:prevention & control / Q000706:statistics & numerical data*; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D013131:Spine / Q000601:surgery*