The aetiology of fusion may be congenital, acquired, or surgical. However, their fusion can very easily misguide the surgeon. The SP of vertebrae, because of its readily accessible location, is commonly used for counting vertebral level. Ībnormal anatomy is one of the risk factors for WLSS. Ammerman JM et al., have reported the incidence of wrong level lumbar spinal surgeries to be as high as 15% while Barrios C et al., have reported it to be around 3.3%. Jhawar BS et al., have also reported that the WLSS are more common in the lumbar region (12.8/10 000) than that of the cervical region (7.6/10 000). Also, out of these wrong level operations, majority were performed on the lumbar region (71%), followed by the cervical (21%), and the thoracic (8%) regions. They reported that the prevalence of wrong level spinal operations to be 1 in 3110 procedures. Mody M et al., had done a questionnaire-based survey among members of the American Academy of Neurosurgeons. The present study has attempted to determine the prevalence of fusion of LSP in cadavers at the Department of Anatomy at the study institute.Īlthough the exact incidence of WLSS remains unknown, most researchers agree that the lumbar level is more prone to WLSS. The knowledge of anatomical variations of spine may help in reducing the incidence of WLSS. WLSS occurs when a surgeon performs decompression, resection, or reconstructive procedure on an unintended anatomic location along the spinal axis. The problem of Wrong Level Spinal Surgery (WLSS) is a unique surgical problem with detrimental consequences for both the patient and the surgeon. The data will be useful to determine the necessity to devise a protocol to look for this variation preoperatively, in patients posted for lumbar spinal surgery. The present study attempted to determine the prevalence of fusion of SP of adjacent lumbar vertebrae, which is one of the risk factors for wrong level lumbar spinal surgery. Operating at the wrong level is avoidable at least in some cases if the surgeon recognises the risk factors. The preoperative assessment of patient with respect to these anatomical variations will help to prevent the errors in counting of vertebral level. Other anatomical variations which may lead to errors in counting of vertebral level include presence of cervical ribs, absence of thoracic ribs, hemivertebrae, sacralisation of lumbar vertebra etc. However, the fusion of SP of adjacent lumbar vertebrae is one such factor that may cause errors in counting of lumbar vertebrae which in turn may result in operating at the wrong spinal level. The LSP is relatively superficial and easy to access. Anatomical variations are major risk factors that make the determination of the correct spinal level very challenging. Many researchers have tried to enlist the factors that have the potential to mislead the surgeons to commit this error. Jhawar BS et al., have reported the incidence of wrong level lumbar spinal surgeries to be 12.8 per 10,000 surgeries. This type of error can cost very dearly to the financial and professional well-being of the surgeons. This not only requires the patients to undergo additional surgeries but many times results in litigations. Spine surgery at the wrong level is an unintended, yet not so uncommon mistake committed by surgeons around the world. A lumbar vertebra has a thick and stout vertebral body, a blunt, quadrilateral Spinous Process (SP) for the attachment of strong lumbar muscles, and articular processes. The vertebral arch consists of a pair of pedicles and a pair of laminae, which encircles the vertebral foramen. Lumbar vertebra has a vertebral body and a vertebral arch.
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