CLINICAL ARTICLE

 

Optimising safety in the spine theatre

 

 

RN Dunn^I; MJ Jacobsohn^II

^IMBChB(UCT), MMed(Orth), FCS(SA)Orth; Consultant Spine and Orthopaedic Surgeon, Head Spine Services: Groote Schuur Hospital, Division of Orthopaedic Surgery, University of Cape Town
^IIMBCHB, FCS(Neuro)SA; AOSpine Fellow, Spine Surgery Unit, Groote Schuur Hospital, Division of Orthopaedic Surgery, University of Cape Town

Correspondence

 

 

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ABSTRACT

With the proliferation of spinal surgery, both in numbers of cases annually and variety of surgery, there has been an increase in complications and associated litigation. Fager reports that up to 40% of cases were non-defensible.
A review of the published literature was performed to highlight some of the more common aspects in an effort to highlight them to the spine surgeon in an attempt to reduce their incidence and optimise safety in theatre.
The following issues are discussed:
Wrong level surgery

• Patient positioning
• Infection risk and rituals
• Neurophysiological monitoring
• Neuronavigation.

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References

1. Wilson-MacDonald J, Fairbank J, Frost H et al. The MRC spine stabilization trial: surgical methods, outcomes, costs, and complications of surgical stabilization. Spine 2008 Oct 1;33(21):2334-40.         [ Links ]

2. Fager CA. Malpractice issues in neurological surgery. Surg Neurol 2006 Apr;65(4):416-21.         [ Links ]

3. Bearden BG, Conrad BP, Horodyski MB, Rechtine GR. Motion in the unstable cervical spine: comparison of manual turning and use of the Jackson table in prone positioning. Journal of Neurosurgery Spine Aug 2007;7(2):161-4.         [ Links ]

4. Mofredj A, Traore I, Beldjoudi B, Aoula D, Douiri R. Acute bowel ischemia following spinal surgery. South Med J 2006 May;99(5):528-30.         [ Links ]

5. Park CK. The effect of patient positioning on intraabdominal pressure and blood loss in spinal surgery. Anesth Analg 2000 Sep;91(3):552-7.         [ Links ]

6. Dharmavaram S, Jellish WS, Nockels RP, Shea J, Mehmood R, Ghanayem A, Kleinman B, Jacobs W. Effect of prone positioning systems on hemodynamic and cardiac function during lumbar spine surgery: an echocardiographic study. Spine 2006 May 20; 31(12):1388-93        [ Links ]

7. Palmon SC, Kirsch JR, Depper JA, Toung TJ. The effect of the prone position on pulmonary mechanics is frame-dependent. Anesth Analg 1998 Nov;87(5):1175-80.         [ Links ]

8. Moody MG, Nourbakhsh A, Stahl DL, Gibbs M, Alfawareh M, Garges KJ. The prevalence of wrong level surgery among spine surgeons. Spine 2008 Jan 15;33(2):194-8.         [ Links ]

9. Michaels RK, Makary MA, Dahab Y, Frassica FJ, Heitmiller E, Rowen LC, Crotreau R, Brem H, Pronovost PJ. Achieving the national quality forum's 'never events': prevention of wrong site, wrong procedure, and wrong patient operations. Ann Surg 2007 Apr;245(4):526-32.         [ Links ]

10. Haynes AB, Weiser TG, Berry WR et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Eng J Med 2009 Jan;360(5):491-9.         [ Links ]

11. Redfern S. Myths and rituals in the operating suite. 1998. MSc Dissertation, Monash University, Australia).         [ Links ]

12. Woodhead K, Taylor EW, Bannister G et al. Behaviours and rituals in the operating theatre. A report from the Hospital Infection Society Working Group on Infection Control in the Operating Theatres. www.his.org.uk/_db/_documents/Rituals-02.doc        [ Links ]

13. Editorial. OR Manager 1997;13:8.         [ Links ]

14. Brown GH. The Sacred Cow Contest: The Canadian Nurse 1993;89:31-3.         [ Links ]

15. Cruse PJ, Foord R. A five-year prospective study of 23,649 surgical wounds. Arch Surg 1973;107:206-10.         [ Links ]

16. Thur de Koos P, McComas B. Shaving versus skin depilatory cream for preoperative skin preparation. A prospective study of wound infection rates. Am J Surg 1983;145:377-8.         [ Links ]

17. Alexander JW, Fischer JE, Boyajian M, Palmquist J, Morris MJ . The influence of hair removal methods on wound infections. Arch Surg 1983;118:347-52.         [ Links ]

18. Garibaldi RA, Skolnick D, Lerer T, Poirot A, Graham J, Krisuinas E, Lyons R. The impact of preoperative skin disinfection on preventing intraoperative wound contamination. Infect Control Hosp Epidemiol 1988;9:109-13.         [ Links ]

19. Kaiser AB, Kernodle DS, Barg NL, Petracek MR. Influence of preoperative showers on staphylococcal skin colonization: a comparative trial of antiseptic skin cleansers. Ann Thorac Surg 1988;45:35-8.         [ Links ]

20. Byrne DJ, Napier A, Cuschieri A. Rationalizing whole body disinfection. J Hosp Infect 1990;15:183-7.         [ Links ]

21. Dineen P. An evaluation of the duration of the surgical scrub. Surg Obstet 1969;129:1181-4.         [ Links ]

22. Rehork B, Ruden H. Investigations into the efficacy of different procedures for surgical hand disinfection between consecutive operations. J Hosp Infect 1991; 19:115-27.         [ Links ]

23. Lilly HA, Lowbury EJ. Disinfection of the skin: an assessment of some new preparations. BMJ 1971; 3:674-6.         [ Links ]

24. Podnos YD, Irvine CA, Williams RA, Orange CA. American College of Surgeons: Committee on Perioperative Care: Fires in the Operating Room. http://www.facs.org/about/committees/cpc/oper0897.html        [ Links ]

25. Kelleher MO, Tan G, Sarjeant R, Fehlings MG. Predictive value of intraoperative neurophysiological monitoring during cervical spine surgery: a prospective analysis of 1055 consecutive patients. J Neurosurg Spine 2008 Mar;8(3):215- 21.         [ Links ]

26. Schwartz DM, Auerbach JD, Dormans JP, et al. Neurophysiological detection of impending spinal cord injury during scoliosis surgery. J Bone Joint Surg Am 2007 Nov;89(11):2440-9.         [ Links ]

27. Pelosi L, Lamb J, Grevitt M, Mehdian SM, Webb JK, Blumhardt LD. Combined monitoring of motor and somatosensory evoked potentials in orthopaedic spinal surgery. Clin Neurophysiol 2002 Jul;113(7):1082- 91.         [ Links ]

28. Cheh G, Lenke LG, Padberg AM, Kim YJ, Daubs MD, Kuhns C, Stobbs G, Hensley M. Loss of spinal cord monitoring signals in children during thoracic kyphosis correction with spinal osteotomy: why does it occur and what should you do? Spine 2008 May 1;33(10):1093-9.         [ Links ]

29. Taunt CJ Jr, Sidhu KS, Andrew SA. Somatosensory evoked potential monitoring during anterior cervical dis- cectomy and fusion. Spine. 2005 Sep 1; 30(17):1970-2.         [ Links ]

30. Patrick N. Smith, Jeffrey R. Balzer, Mustafa H. Khan et al. Intraoperative somatosensory evoked potential monitoring during anterior cervical discectomy and fusion in nonmyelopathic patients - a review of 1,039 cases Spine J. 2007 Jan-Feb;7(1):83-7.         [ Links ]

31. Ebmeier K, Giest K, Kalff R. Intraoperative computerized tomography for improved accuracy of spinal navigation in pedicle screw placement of the thoracic spine. Acta Neurochir Suppl 2003;85:105-13.         [ Links ]

32. Weinstein JN, Spratt KF, Spengler D, Brick C, Reid S. Spinal pedicle fixation: Reliability and validity of roentgenogram based assessment and surgical factors on successful screw placement. Spine 1988 Sep; 13(9):1012-8.         [ Links ]

33. Schulze CJ, Munzinger E, Weber U. Clinical relevance of accuracy of pedicle screw placement. A computed tomographic-supported analysis. Spine 1998 Oct 15; 23(20):2215-20.         [ Links ]

34. Foley KT, Smith MM. Image-guided spine surgery. Neurosurg Clin North Am 1996;7:171-86.         [ Links ]

35. Kalfas IH, Kormos DW, Murphy MA. Application of frameless stereotaxy to pedicle screw fixation of the spine. J Neurosurg 1995;83:641-7.         [ Links ]

36. Sasso RC, Garrido BJ. Computer-assisted spinal navigation versus serial radiography and operative time for posterior spinal fusion at L5-S1J. Spinal Disord Tech 2007 Apr;20(2):118-22.         [ Links ]

37. Liljenqvist UR, Halm HF, Link TM. Pedicle screw instrumentation of the thoracic spine in idiopathic scoliosis. Spine 1997;22:2239-45.         [ Links ]

38. Vaccaro AR, Rizzolo SJ, Balderson RA. Placement of pedicle screws in the thoracic spine: II. An anatomical and radiographic assessment. J Bone Joint Surg [Am] 1995;77:1200-6.

39. Youkilis AS, Quint DJ, McGillicuddy JE. Stereotactic navigation for placement of pedicle screws in the thoracic spine. Neurosurgery 2001;48:771-81.         [ Links ]

40. Foley KT, Silveri CP, Vaccaro AR. Atlantoaxial transarticular screw fixation: Risk assessment and bone morphology using an image guidance system. J Bone Joint Surg [Br] 1998;80(Suppl):245.

 

 

Correspondence:
Dr RN Dunn
Department of Orthopaedic Surgery
Groote Schuur Hospital
H49 OMB
Observatory
Tel: (021) 404-5387; Fax: 086 6715 294
Email: info@spinesurgery.co.za

 

 

No benefits of any form have been received from a commercial party related directly or indirectly to the subject of this article.