J Minim Invasive Spine Surg Tech.  2017 Jun;2(1):39-43. 10.21182/jmisst.2017.00220.

The 'Nightmare' of Wrong Level in Spine Surgery: Is Minimally Invasive Spine Technique More Forgiving?

• KMID: 2562025
• DOI: http://doi.org/10.21182/jmisst.2017.00220

Abstract

Objective
Operating on a wrong level is a nightmare for every surgeon, which has devastating consequences for the patient as well as the surgeon and has potential for serious medical, personal and legal repercussions. There is limited literature of Wrong Level Spine Surgery (WLSS) in Minimally Invasive Spine Surgery (MISS). The aim of the study is to evaluate the incidence of WLSS in MISS using tubular retractors. Methods: The study included a retrospective review of prospectively collected data of all MIS surgeries utilizing tubular retractors during the period extending from January 2007 to December 2014. The surgeries included Micro-Endoscopic Discectomies, Micro-Endoscopic Decompression surgeries for lumbar canal stenosis and Minimal Invasive Trans-Foraminal Lumbar Interbody Fusion (MI-TLIF) surgeries. The surgeries involved docking of the tubular retractor at the level of interest under fluoroscopic guidance. Surgical charts as well as clinical and imaging followup data were analyzed. The incidence of WLSS was analyzed. Results: There were 1,043 surgeries in all in the study period. There were 393 discectomies, 370 decompressions and 280 MI-TLIF surgeries. There were no wrong level surgeries in the entire series. There were two (0.19%) wrong side tube dockings which were subsequently rectified during surgery. No clinical complications were seen. The results were reviewed in light of a meta-analysis of current literature available on WLSS in open and MISS. The results were consistent with the present literature in demonstrating a decreased incidence of WLSS with MISS. Conclusion: The docking of the tubular retractor under fluoroscopic guidance offers an advantage of preventing WLSS. This is an additional benefit of MISS using tubular retractors.