Dablouk Mohamed O, Sajjad Jahangir, Lim Chris, Kaar George, O'Sullivan Michael G J
a Department of Neurosurgery , Cork University Hospital , Wilton, Cork , Republic of Ireland.
Br J Neurosurg. 2019 Jun;33(3):352-356. doi: 10.1080/02688697.2018.1562030. Epub 2019 Feb 11.
Retrospective review of the practice of 3 surgeons in a single centre during a 1-year period. We aimed to investigate our adherence to the Society of British Neurological Surgeons (SBNS) guidelines regarding intra-operative imaging during lumbar surgery and to determine if this has any impact on length of surgery or complications rates, in particular rates of wrong-level surgery. The SBNS recommends three x-rays for intra-operative spinal localisation - one prior to incision, the second after exposure of the laminae and before the commencement of decompression, and the third at the end of the operation to confirm the adequacy of decompression. At our centre, surgeon A performs x-rays 1 and 3 routinely, and x-ray 2 in cases where the anatomy is uncertain, surgeon B performs x-ray 2 only, and the practice of surgeon C varies depending on the complexity of cases. We reviewed the surgical logbooks of 3 consultant neurosurgeons in our centre for the 1-year period between October 2015 and October 2016. Our study included 301 patients who had undergone lumbar decompression or lumbar discectomy during this period. There were no cases of wrong-level surgery. The incorrect spinal level was initially exposed in 13 cases (4.3%). 10 of these had x-ray 2 only, 1 had x-ray 1, 1 had x-rays 1 and 2, and 1 had all 3 x-rays. Surgeon B performed 8 of these cases, four were performed by surgeon C, and 1 by surgeon A. The median duration of surgery was 80 minutes for lumbar decompression and 67.5 minutes for lumbar discectomy. The median duration of surgery in patients in whom the wrong level was initially exposed was 85 minutes for lumbar decompression and 80 minutes for lumbar discectomy. Performance of the 3 recommended x-rays may increase the identification of wrong-level exposures before the commencement of decompression and may reduce the length of surgery.
对一家中心的3位外科医生在1年期间的手术操作进行回顾性研究。我们旨在调查我们在腰椎手术中对英国神经外科医生协会（SBNS）关于术中成像的指南的遵守情况，并确定这是否对手术时长或并发症发生率有任何影响，特别是错误节段手术的发生率。SBNS建议在术中进行三次X线检查以定位脊柱——一次在切口前，第二次在椎板暴露后且减压开始前，第三次在手术结束时以确认减压是否充分。在我们中心，外科医生A常规进行第1次和第3次X线检查，在解剖结构不确定的情况下进行第2次X线检查；外科医生B仅进行第2次X线检查；外科医生C的做法则根据病例的复杂程度而有所不同。我们回顾了我们中心3位神经外科顾问医生在2015年10月至2016年10月这1年期间的手术记录。我们的研究纳入了在此期间接受腰椎减压或腰椎间盘切除术的301例患者。没有错误节段手术的病例。最初暴露了错误脊柱节段的有13例（4.3%）。其中10例仅进行了第2次X线检查，1例进行了第1次X线检查，1例进行了第1次和第2次X线检查，1例进行了全部3次X线检查。这些病例中8例由外科医生B进行手术，4例由外科医生C进行手术，1例由外科医生A进行手术。腰椎减压手术的中位时长为80分钟，腰椎间盘切除术的中位时长为67.5分钟。最初暴露了错误节段的患者中，腰椎减压手术的中位时长为85分钟，腰椎间盘切除术的中位时长为80分钟。进行3次推荐的X线检查可能会增加在减压开始前识别错误节段暴露的几率，并可能缩短手术时长。
