Shah Manan, Halalmeh Dia R, Sandio Aubin, Tubbs R Shane, Moisi Marc D
Neurosurgery, Wayne State University, Detroit Medical Center, Detroit, USA.
Neurosurgery, Detroit Medical Center, Detroit, USA.
Cureus. 2020 Jun 18;12(6):e8684. doi: 10.7759/cureus.8684.
Spine surgery at the wrong level is a detrimental ordeal for both surgeon and patient, and it falls under the wrong-site surgery sentinel events reporting system. While there are several methods designed to limit the incidence of these events, they continue to occur and can result in significant morbidity for the patient and malpractice lawsuits for the surgeon. In thoracic spine, numerous risk factors influence the development of this misadventure. These include anatomical variations such as transitional vertebrae, rib variants, hemivertebra, and block/fused vertebrae as well as patient characteristics, such as tumors, infections, previous thoracic spine surgery, obesity, and osteoporosis. An extensive literature search of the PubMed database up to 2019 was completed on each of the anatomical entities and their influence on developing thoracic spine surgery at the wrong level, taking into consideration patient's individual factors. A reliable protocol and effective techniques were described to prevent this error. In addition, the surgeon should collaborate with radiologists, particularly in challenging cases. A thorough understanding of the surgical anatomy and its variants coupled with patients characteristic is crucial for maximal patient benefit and avoidance of thoracic spine surgery at the wrong level.
脊柱手术节段错误对医生和患者来说都是一场有害的折磨，它属于手术部位错误的哨兵事件报告系统范畴。虽然有多种方法旨在降低这些事件的发生率，但它们仍在发生，并且可能给患者带来严重的并发症，给医生带来医疗事故诉讼。在胸椎手术中，众多风险因素会影响此类失误的发生。这些因素包括解剖变异，如移行椎、肋骨变异、半椎体以及椎体融合，还有患者自身特征，如肿瘤、感染、既往胸椎手术史、肥胖和骨质疏松。考虑到患者个体因素，对截至2019年的PubMed数据库进行了广泛的文献检索，针对每个解剖实体及其对胸椎手术节段错误发生的影响进行了研究。文中描述了可靠的方案和有效的技术来预防此类错误。此外，医生应与放射科医生合作，尤其是在具有挑战性的病例中。全面了解手术解剖结构及其变异情况，并结合患者特征，对于使患者获得最大益处以及避免胸椎手术节段错误至关重要。
