Approximately one in every 3,100 surgical procedures on the spine is performed at the wrong place. To reduce these errors, Johns Hopkins researchers have devised software that, in clinical evaluations, accurately labeled different levels of the spine on X-rays taken during surgery.

Biomedical engineer Jeff Siewerdsen, the leader of the team, says the software, LevelCheck, does not replace the surgeon’s expertise, but “it offers helpful guidance and decision support, like your GPS.”

Using a high-speed processing unit, the technology combines a patient’s CT scan from before surgery with X-rays taken during surgery. After matching the X-ray to the CT scan, LevelCheck labels the vertebrae on the X-ray, which surgeons can use in real time during the operation. A recent study showed the software was 100 percent accurate in labeling the spine correctly.

Traditionally, several X-rays are taken in the operating room to determine where to perform surgery. One X-ray overlaps another until the entire spine can be seen. After identifying the target area, surgeons then count the number of vertebrae from the top or bottom of the spine to the target area where the procedure needs to take place.  

Neurosurgeon Jean-Paul Wolinsky says it can be challenging to count. Some people have more bones in one area of the spine. For others, some bones are smaller and can be missed. Plus, the bone quality might not show up well on the X-ray.

When there is a mistake and surgery takes place at the wrong level, it can result in pain, follow-up surgeries or degeneration of the spine. Financially, each wrong-level surgery is estimated to cost more than $100,000.

Siewerdsen and his team continue to evaluate LevelCheck’s performance and benefits, and they hope it will be ready for licensing by 2016. LevelCheck is the first offshoot of a program called Operating Room Quality Assurance, which is funded by the National Institutes of Health to develop safer ways of imaging in the operating room.