The 'nightmare' Of Wrong Level In Spine Surgery: Is Minimally Invasive Spine Technique More Forgiving?

Presented at SMISS Global Forum 2014
By Arvind Kulkarni MS(ORTH) Dip(ORTH) FCPS Dip(SICOT)

Disclosures: Arvind Kulkarni MS(ORTH) Dip(ORTH) FCPS Dip(SICOT) None

Introduction:
The advantages of MISS over open surgery include minimal tissue / muscle trauma, less blood loss, low rate of perioperative complications, minimal post operative morbidity, decreased hospital stay and eventually cost. Among the perioperative incidents, operating on a wrong level (Wrong Level Spine Surgery) is a nightmare for every surgeon. It has devastating consequences for the patient as well as the surgeon and has the potential for serious medical, personal, and legal repercussions. So far very few studies have reported on the relation between MISS and WLSS.

Aims/Objectives:
The present study was done 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 January 2013. The surgeries included micro-endoscopic discectomies, micro-endoscopic decompression for lumbar stenosis and minimal invasive trans-foraminal lumbar inter-body fusion surgeries. The surgeries involved docking of the tubular retractor at the level of interest under fluoroscopic guidance. Surgical charts as well as clinical and neuroimaging follow-up data were analysed. The incidence of WLSS was analysed.

Results:
There were 414 surgeries in all in the study period. There were 188 discectomies, 138 decompressions and 88 MI-TLIF surgeries. There were no wrong level surgeries in the entire series.There were two [0.48 %] wrong side tube dockings which were subsequently rectified during surgery. The results were reviewed in light of a metaanalysis 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.

Conclusions:
The final docking of the tubular retractor under fluoroscopic guidance offers an advantage of preventing WSSS. This is an additional benefit of MISS using tubular retractors apart from achieving the goals of surgery leaving the minimal possible surgical footprint.