spine can be most
problematic because
surgeons are not able
to see the sacrum or
the C2 vertebrae at the
same time. Most oper-
ating rooms are limit-
ed because C-arms
don't provide full-body
fluoroscopic images,
so surgeons must
place an artificial
marker to identify a place to start their count to the correct vertebrae.
Most spine surgeons make three localized counts to confirm the
intended surgical site. One takes place pre-incision. After the patient
is intubated, anesthetized and positioned for surgery, the first intraop-
erative image is taken with a C-arm. My general practice is to place a
needle through the skin for the pre-incision imaging. The needle over-
lays the area of the spine I want to operate on. It shows up on the X-
ray so I can confirm that it's at the vertebrae that needs repair.
The second X-ray is taken after the incision is made. The bone is
exposed, but before the actual procedure has begun. I place a surgical
tool on the bone and capture another image to make sure the bone
I'm about to remove is the correct one. The count I make ends when I
get to the disc that has the tool atop it. A third and final X-ray is taken
after the procedure has been completed to confirm the location was
correct.
2. Perform separate time outs
The main culprit for wrong-site surgeries is a simple counting error
J U N E 2 0 2 0 • O U T P A T I E N T S U R G E R Y . N E T • 1 0 3
BACK TO BASICS Everyone involved in a case should actively participate in
processes put in plance to ensure the surgeon operates at the correct spine level.
