Table 1 Summary of the key statements from the Article

Types

Wrong-level spine surgery (WSS) - the primary focus, involving surgery at an unintended vertebral level. While the abstract doesn’t explicitly detail other types, “wrong site” broadly includes wrong side (left vs. right) and wrong patient.

Causes

Communication Failures: Inadequate information exchange among the surgical team (preoperative, intraoperative).

Inadequate Preoperative Planning: Insufficient review of imaging, lack of clear surgical plans and marking, failure to account for anatomical variations.

Insufficient Surgical Protocols: Absence or inadequate implementation of safety checklists, lack of standardized level verification procedures, reliance on subjective assessment without technological aids.

Technical Challenges: Difficulties in intraoperative level identification due to patient factors (obesity, prior surgery, deformities), poor imaging quality, subtle anatomical differences between vertebral levels (especially in the thoracic spine).

Human Factors: Surgeon fatigue, rushing, inattention to detail.

Consequences

Devastating Patient Outcomes: Unnecessary surgery at the wrong level can lead to neurological deficits, pain, the need for revision surgery, prolonged recovery, and psychological distress.

Healthcare System Burden: Increased costs associated with revision surgeries, prolonged hospital stays, potential litigation, and damage to the reputation of the healthcare institution.

Prevention

Advanced Technologies: Integration of artificial intelligence, advanced imaging techniques (e.g., 3D imaging), and surgical navigation systems to enhance accuracy.

Established Safety Protocols: Consistent and rigorous use of digital checklists, simulation training for surgical teams, standardized level verification processes (e.g., intraoperative imaging with clear markers).

Continuous Education: Ongoing training and awareness programs for all surgical team members to reinforce safety protocols and the importance of meticulous attention to detail.

Culture of Safety: Fostering an environment where open communication, error reporting, and a proactive approach to risk mitigation are prioritized.

Higher Risk Procedures/Regions

Procedures in patients with anatomical variations, prior spine surgery, or spinal deformities. The thoracic spine is identified as a region with a higher risk due to fewer reliable bony landmarks and imaging challenges.