Wrong-level spine surgery: A multicenter retrospective study.

BACKGROUND: Wrong-level spine surgery is a rare but serious complication of spinal surgery that increases patient harm and legal risks. Although such surgeries have been reported by many spine surgeons, they have not been adequately investigated. Therefore, this study aimed to examine the causes and preventive measures for wrong-level spine surgeries. METHODS: This study analyzed cases of wrong-level spine surgeries from 10 medical centers. Factors such as age, sex, body mass index, preoperative diagnosis, surgical details, surgeon's experience, anatomical variations, responses, and causes of the wrong-level spine surgeries were studied. The methods used by the surgeons to confirm the surgical level were also surveyed using a questionnaire for each surgical procedure and site. RESULTS: Eighteen cases (13 men and 5 women; mean age, 61.2 years; mean body mass index, 24.5 kg/m2) of wrong-level spine surgeries were evaluated in the study. Two cases involved emergency surgeries, three involved newly introduced procedures, and five showed anatomical variations. Wrong-level spine surgeries occurred more frequently in patients who underwent posterior thoracic surgery than in those who underwent other techniques (p < 0.01). Twenty-two spinal surgeons described the methods used to confirm the levels preoperatively and intraoperatively. In posterior thoracic laminectomies, half of the surgeons used preoperative markers to confirm the surgical level and did not perform intraoperative fluoroscopy. In posterior thoracic fusion, all surgeons confirmed the level using fluoroscopy preoperatively and intraoperatively. CONCLUSIONS: Wrong-level spine surgeries occurred more frequently in posterior thoracic surgeries. The thoracic spine lacks the anatomical characteristics observed in the cervical and lumbar spine. The large drop in the spinous process can make it challenging for surgeons to determine the positional relationship between the spinous process and the vertebral body. Moreover, unfamiliarity with the technique and anatomical variations were also risk factors for wrong-level spine surgeries.

Pre- and intraoperative thoracic spine localization techniques: a systematic review.

OBJECTIVE: In the era of modern medicine with an armamentarium full of state-of-the art technologies at our disposal, the incidence of wrong-level spinal surgery remains problematic. In particular, the thoracic spine presents a challenge for accurate localization due partly to body habitus, anatomical variations, and radiographic artifact from the ribs and scapula. The present review aims to assess and describe thoracic spine localization techniques. METHODS: The authors performed a literature search using the PubMed database from 1990 to 2020, compliant with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A total of 27 articles were included in this qualitative review. RESULTS: A number of pre- and intraoperative strategies have been devised and employed to facilitate correct-level localization. Some of the more well-described approaches include fiducial metallic markers (screw or gold), metallic coils, polymethylmethacrylate, methylene blue, marking wire, use of intraoperative neuronavigation, intraoperative localization techniques (including using a needle, temperature probe, fluoroscopy, MRI, and ultrasonography), and skin marking. CONCLUSIONS: While a number of techniques exist to accurately localize lesions in the thoracic spine, each has its advantages and disadvantages. Ultimately, the localization technique deployed by the spine surgeon will be patient-specific but often based on surgeon preference.

Vertebrae localization in CT using both local and global symmetry features.

Automatic vertebrae segmentation and localization in CT images are essential in many medical treatments such as disease diagnosis and surgical planning. However, vertebra is one of the most complex organs to locate precisely due to its complex shape, deformation and occlusion by other organs. In this paper, we propose to incorporate local appearance features with global translational symmetry and local reflection symmetry features. Symmetrical structure of each vertebra provides strong cue for accurate localization. In order to efficiently investigate 3-dimensional reflection symmetry in CT images, we propose a Sphere Surface Expansion method and iterative optimization framework. Quantitative and qualitative evaluations show that the proposed method outperforms existing localization method.

Directing GPCR-transfected cells and neuronal projections with nano-scale resolution.

Surface modification technology has made significant advances in recent years towards the miniaturization and organization of traditional cell culture systems. However, the capability of directing transfected cells and neuronal connections to probe small structures such as spines is still under development. In the current work, interactions of different micropatterned substrates with HEK 293, CF10 cell lines, and primary neuronal cultures are evaluated. Using conventional and confocal fluorescence microscopies, several morphological and behavioral aspects of all three cell types were investigated. The immortalized cell lines were able to attach to the substrate and interact with neighboring cells. Similarly, cortical neurons formed connections guided by the micropatterns. Transfection of HEK 293 or CF10 cell lines with specific members of the G protein-coupled receptor family did not alter the behavior of these cells in the micropatterns. On the other hand, neuronal projections were efficiently isolated by the patterns, simplifying the localization of spines with nano-scale resolution probed by atomic force microscopy. This work presents a valuable approach to isolate cells or to constrain important cell structures to grow along a desired pattern, thus facilitating advanced biological studies.