ies, particularly those performed at the cervical-thoracic junction.
Using a three-dimensional CT scan instead of an X-ray in the OR does-
n't change the need to localize the surgery site and count to confirm
you've located it correctly. However, the images do improve my visu-
alization during all steps of the procedures, and I haven't had a single
wrong-site event thanks to my ability to properly identify the correct
spine level during these challenging cases.
Focus on the fundamentals
Although advanced technologies can be invaluable in helping surgical
teams prevent wrong-site surgery during spine cases, the most repro-
duceable solution is the localization time outs. There's no big cost
associated with performing several time outs during a procedure to
confirm the correct site. All it takes is a culture change. Anybody can
make a mistake, but it's hard to imagine multiple members of the sur-
gical team making the exact same counting error if there's a culture in
place that empowers everyone in the OR to speak up to ensure the
surgeon is zeroing in on the right site.
OSM
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 7
The biggest factor
that contributes to surgeons
counting to the wrong
vertebrae is the poor quality
of intraoperative images.
Dr.
Qureshi
(qureshi2@hhs.edu)
is
the
Patty
and
Jay
Baker
endowed
chair
in
minimally
invasive
spine
surgery
at
the
Hospital
for
Special
Surgery
and
an
associate
professor
of
orthopedic
surgery
at
Weill
Cornell
Medical
College
in
New
York
City.
