Department of Neurosurgery, Hospital Igea, Milan, Italy.
J Neurosurg Spine. 2010 Jun;12(6):660-5. doi: 10.3171/2009.12.SPINE09627.
When performing a single-level lumbar decompressive procedure, the first of all errors to avoid is operating at the wrong level or on the wrong side. In this report the authors describe their method of trying to minimize this potential risk.
A 3-step procedure-the IRACE (intraoperative radiograph and confirming exclamation) method-was designed and adopted for single-level lumbar decompressive surgeries. Before skin incision, a wire is placed in the spinous process and lateral fluoroscopy is performed. Subsequently and also before skin incision, the assistant nurse provides oral confirmation of the level and side. Additional fluoroscopic control is provided before starting the laminotomy. The clinical records of 818 consecutive patients who had undergone lumbar microdiscectomy as an initial operation between 2001 and 2005 were retrospectively reviewed. Surgical charts as well as clinical and neuroimaging follow-up data were analyzed.
No patient clinically and/or neuroradiologically demonstrated a level or side error. In 1 (0.12%) of 818 surgical procedures a wrong level was initially explored. The absence of frank disc herniation and the discrepancy with preoperative neuroimages led to fluoroscopic control in this case, and the correct level was then approached. No clinically apparent method-related complications were registered.
The problem of an incorrect level or side in lumbar surgery remains unresolved. The authors propose a useful and easily applied procedure to reduce such a risk. Larger studies comparing different methods of avoiding such errors will probably lead to the definition and wide adoption of a surgical behavior aiming to reach a near-zero error rate.
在行单节段腰椎减压手术时，首先要避免的错误是在错误的节段或侧别进行手术。在本报告中，作者描述了他们试图将这种潜在风险降到最低的方法。
作者设计并采用了一个三步程序（即术中放射和确认感叹号，IRACE），用于单节段腰椎减压手术。在皮肤切开之前，将一根钢丝放置在棘突上，并进行侧位透视。随后，在皮肤切开之前，助手护士口头确认节段和侧别。在开始椎板切开术之前，还进行了额外的透视控制。回顾性分析了 2001 年至 2005 年间连续 818 例接受腰椎显微切除术作为初始手术的患者的临床记录。分析了手术图表以及临床和神经影像学随访数据。
没有患者在临床和/或神经影像学上表现出节段或侧别错误。在 818 例手术中，有 1 例（0.12%）最初探查的节段错误。由于缺乏明显的椎间盘突出和与术前神经影像的差异，在这种情况下进行了透视控制，然后再接近正确的节段。没有记录到明显与方法相关的并发症。
腰椎手术中存在不正确的节段或侧别的问题仍然没有解决。作者提出了一种有用且易于应用的程序，以降低这种风险。比较不同避免此类错误方法的更大研究可能会导致定义和广泛采用旨在达到接近零错误率的手术行为。
