Throughout Safety in Spine Surgery Month—April, 2024—we shared a variety of spine surgery safety resources, including downloadable Best Practice Guidelines and top talks from previous years. A partial listing of these resources is available below.

Best Practice Guidelines:

Video Presentations:

Ever-increasing safety in spine surgery is critical. Keep the conversation going! Continue to watch for exclusive content about spine surgery safety through this website and on your preferred social platforms.

S3P Social Links:

For a more in-depth study of safety best practices and innovations, join us in New York City at the Safety in Spine Surgery Summit on May 31, 2024. Read More >

As part of the 2nd Annual Safety in Spine Surgery Month, we invite you to join us at two live webinars on April 14 and April 21, 2022. These events will be hosted and moderated by the Safety Month Chair Michael Vitale, MD and Co-Chairs John Flynn, MD; Roger Härtl, MD; Larry Lenke, MD; and Rajiv Sethi, MD.

The April 14 webinar will take place at 7:00 pm Eastern Time and will focus on Best Practice Guidelines. It will feature the publication of several checklists and protocols by the Safety in Spine Surgery Project as well as lectures and panel discussions with our esteemed chairs and faculty. In addition, 5 of the award winners of Best New Methodologies and Techniques to Enhance Safety in Spine Surgery will present their papers. This webinar will be CME-accredited. Click here for the full program.

The April 21 webinar will also take place at 7:00 pm Eastern Time. It will focus on Robotics and Navigation and specifically its use across generations of US spine surgeons. The other 5 of this year’s award winners will present at this webinar, plus faculty lectures, discussions, and technology updates from our corporate partners. Click here for the full program.

We hope you’ll join us for these two events and get involved with Safety Month on social media! Post your questions and contributions with the hashtags #safetyinspinesurgery and #s3p. Follow us on Twitter, Facebook, Linkedin, and Instagram for daily posts of Best Practice Guidelines and further resources.

We are looking forward to an exciting month of collaboration!

The Safety in Spine Surgery Project (S3P) is pleased to announce the 10 winners of the Safety in Spine Surgery Month Call for Abstracts / Call for Projects.

These award winners will present their work during our two live webinars in April.

April 14 Webinar | Best Practice Guidelines & Checklists to Make Your OR Safer
  • Artificial Neural Network Model for Prediction of Perioperative Blood Transfusion in Adult Spinal Deformity Surgery
    Rafael De la Garza Ramos, MD
    Montefiore Medical Center
  • Formulation of a Web-based Spine Surgery Checklist
    Arvind G. Kulkarni, MD
    Mumbai Spine Scoliosis & Disc Replacement Centre
  • Post-operative Steroids in Patients with Severe Neuromuscular Scoliosis Undergoing Posterior Spinal Fusion Reduced Opioid Usage by 70%
    Nicholas Fletcher, MD
    Children's Healthcare of Atlanta/Emory University
  • Starting Enhanced Recovery After Surgery (ERAS) from Scratch at an Academic Institution Spine Program
    Luke Harris
    University of South Alabama
  • Best Practice Consensus Guidelines for Diagnosing, Treating, and Preventing Surgical Site Infections in High-risk Scoliosis
    Paul Sponseller, MD
    Johns Hopkins Medicine

April 21 Webinar | Robotics & Navigation in Spine Surgery: Views Across Generations of Spine Surgeons
  • A Radiographic Comparison of Spinal Navigation and Freehand Techniques in Thoracolumbar Pedicle Screw Insertion
    Mohammed Munim
    Midwest Orthopaedics at RUSH, Rush University Medical Center
  • Augmented Reality to Increase Safety in Minimally Invasive Transforaminal Lumbar Interbody Fusion with Total Navigation
    Fabian Sommer, MD
    Weill Cornell Medicine/New York Presbyterian
  • Novel 2D Long Film Imaging Utility to Avoid Wrong Level Spinal Surgery
    Rajiv Dharnipragada, BA
    University of Minnesota
  • Safety and Feasibility of Augmented Reality-assisted Resection of Benign Intradural Extramedullary Tumors
    Fabian Sommer, MD
    Weill Cornell Medicine/New York Presbyterian
  • The Adjunct Use of Descending Neurogenic-evoked Potentials When Transcranial Motor-Evoked Potentials Degrade into Warning Criteria: Minimizing False-Positive Events
    Scott J. Luhmann, MD
    Washington University

Thank you for participating in Safety in Spine Surgery Month! We closed out the month with an excellent April 29 webinar on Leveraging the Team to Make Spine Surgery Safer. The replay will be available on our website next week.

Our last week of safety videos included some outstanding content & practical tips. We heard from:

  • Dr. Nicholas Fletcher on Mean Arterial Pressure Parameters
  • Dr. Sumeet Garg on Getting the Team on the Same Page
  • Dr. Jean-Pierre Mobasser on the Risks of K Wires and Guidewires in Spine Procedures
  • Dr. Michael Glotzbecker on Overcommunication
  • Dr. Massimo Balsano on his safety tips
  • Dr. Suken Shah on the Surgeon Performance Program
  • Dr. David Skaggs on Setting up Systems
  • Dr. Roger Härtl and Dr. Jacob Goldberg on Emergency Workflow Training

As always, you can review all these videos, plus our library of past talks, for free on the website.

We want to thank this week’s contributors, as well as this week’s partner organizations: SMISS, ISASS, SRS, Setting Scoliosis Straight Foundation, and POSNA.

We hope you’ll join us for next year’s Safety in Spine Surgery Summit (Spring 2022 in New York).

View all this week’s videos here.

Did you catch these highlights from Safety in Spine Surgery Month, Week 3? Our April 15 webinar was packed full of practical advice on implementing checklists and guidelines, and the faculty included leaders from the SRS, the AANS, POSNA, and more. We jammed a lot of education into those 2 hours! You can catch the replay on our website here.

Since we are talking about checklists, do you know about all the free safety in spine surgery resources on the S3P website? We have risk severity scores, checklists, pathways, and more.

We also continue to post daily videos about safety from a variety of leaders across all our social media channels. I think these videos are getting better and better! This week’s videos included:

  • Carlton Weatherby from Medtronic talking about their steadfast commitment to unmatched quality.
  • Dr. John Smith sharing about the success he’s seen in dedicated surgical teams and checklists—they make surgery “much more efficient, safer, and fun.”
  • We posted a clip from Dr. Roger Härtl’s 2020 talk about the market approval process for new technology.
  • Dr. Kevin Shea told us about the POSNA Safe Surgery Program. Learn more here.
  • Dr. Rick Sasso explained the No Strikeout Protocol he developed at the CSRS. This resource is free to download, too.
  • Dr. Chris Hardesty shared about peri-op care protocols, which “help remove variation in practice, which can help decrease variation in outcomes.”
  • Finally, we capped off the week with General Stan McChrystal, our Keynote Lecturer at the 2018 Safety in Spine Surgery Summit, sharing his thoughts on how teams impact safety.

As always, you can review all these videos, plus our library of past talks, for free on the website.

We want to thank this week’s contributors, as well as this week’s partner organizations: Medtronic, Pediatric Spine Study Group & the Pediatric Spine Foundation, POSNA, and the CSRS.

We still want to hear from you! Post safety tips or questions on your own social media—tag us, and you might win a $100 gift card! Winners are drawn each week from all social media channels.

View all this week’s videos here.

We had some amazing videos sharing the message about safety in spine surgery, with both top-level commentary as well as practical tips. This week our daily safety tip videos were seen by over 11,000 people, and our overall audience grew by 40%. Highlights included:

  • Dr. Lehman asked us, “Why is it safer to fly in an airplane than to have surgery?,” in his video on Safety By the Numbers.
  • Prof Carl-Eric Aubin shared about the biomechanical considerations in assessing spinal instrumentation for safety.
  • Vafa Jamali from Zimmer Biomet shared about their support of the Safety month.
  • Dr. Hey shared about the importance of spine surgery checklists, including a link to the downloadable checklists he’s created.
  • And finally, Dr. Elowitz explained the connections between communication, patient safety, and medical malpractice.

Several of these daily tip videos are taken from longer talks presented at past Safety in Spine Surgery Summits. Did you know we have a library of these talks that you can browse & watch for free? Visit the videos tab on our website, or start here with the 2020 Safety Summit videos.

We also had over 500 people register for the April 15 webinar Checklists & Guidelines Which Make Spine Surgery Safer, which featured 4 of our Award Winners for the Best New Methodologies and Techniques to Enhance Safety in Spine Surgery, as well as a “who’s who” of surgeon leaders representing spine safety efforts from leading societies including the SRS, AANS, and POSNA.

We want to thank this week’s contributors, as well as this week’s partner organizations: NewYork-Presbyterian, Medtronic, Zimmer Biomet, NeuroPoint Alliance, Hey Clinic, and CareGuard.

We want to hear from you, too! Post safety tips or questions on your own social media—tag us, and you might win a $100 gift card! Winners are drawn each week from all social media channels.

View all this week’s videos here.

The Safety in Spine Surgery Project (S3P) is pleased to announce the 10 winners of the Safety in Spine Surgery Month Call for Abstracts / Call for Projects. The winning submissions for Best New Methodologies and Techniques to Enhance Safety in Spine Surgery will present their work during two live webinars for Safety in Spine Surgery Month. The free webinars will be held on April 15 and April 29. Registration and further details are available at the link below.

April 15 Webinar

Checklists and Guidelines which Make Spine Surgery Safer
  • Spine Surgery Checklist: A Step towards Perfection through Protocols
    Jwalant Patel, MS, FASSI; Arvind Kulkarni, MS
  • Establishing a Standardized Protocol for Identifying Patients at High Risk for DVT/PE Following Spine Surgery
    Zeeshan Sardar, MD, MSc; Kristen Mitchell, PA; Rick Leung, PA; Derek Mazique, MD
  • Surgical Site Infection Following Neuromuscular Posterior Spinal Fusion Fell 72% After Adopting the 2013 Best Practice Guidelines
    Stephen R. Stephan, MD; Kenneth D. Illingworth, MD; Kavish Gupta, MD; Lindsay M. Andras, MD; David L. Skaggs, MD MMM
    Cedars-Sinai Medical Center & Children’s Hospital Los Angeles
  • Learning from Air Travel: Utilizing a Checklist Prior to Closing (Landing) in Pediatric Spine Surgery
    Jessica H. Heyer, MD; Patrick J. Cahill, MD; John M. Flynn, MD; Jason B. Anari, MD
    Children’s Hospital of Philadelphia

April 29 Webinar

Leveraging the Team to Make Spine Surgery Safer
  • Reduction of Facial Pressure Injuries after Prone Positioning in Spine Surgery: A Multi-Disciplinary Approach
    Mindy Stites, MSN, APRN; Brandon B. Carlson, MD MPH; Linda Brookman, RN; Jake Kessen, CRNA; David Pennington, CRNA; Jacob Birlingmair, MD; Kabir A. Torres, BA; Douglas C. Burton, MD
    University of Kansas Health System
  • Design and Implementation of an Enhanced Recovery After Surgery (ERAS) Protocol in Elective Lumbar Spine Fusion by Posterior Approach: A Retrospective, Comparative Study
    Bhavuk Garg, MS, MRCS; Nishank Mehta, MS; Tungish Bansal; Shubhankar Shekhar; Puneet Khanna; Dalim Vaidya
    All India Institute of Medical Sciences
  • Comparison of Procedural Utilization Rates and Timeline to Care in Multidisciplinary versus Unidisciplinary Spine Clinic Models
    Joshua Benton, BA; Vijay Yanamadala, MD, MBA, MS; Brandon T. Weiss BS; Wenzhu B. Mowrey, PhD; Michael Longo, BA; Rafael De La Garza Ramos, MD; Yaroslav Gelfand, MD; Phillip Cezayirli, MD; Erida Castro-Rivas, MS; Mark Headlam, BS; Adaobi Udemba, NP; Lavinia Williams, RN; Merritt D. Kinon, MD; Andrew I. Gitkind, MD, MHA; Reza Yassari, MD, MS
  • Multidisciplinary Conference for Complex Surgery Leads to Improved Quality and Safety
    Zoe Norris, BFA; Michelle Zabat, BA; Hershil Patel, BS; Nicole Mottole, BS; Kimberly Ashayeri, MD; Eaman Balouch, MD PhD; Constance Maglaras, PhD; Themistocles Protopsaltis, MD; Aaron Buckland, MBBS FRACS; Charla Fischer, MD
    NYU Langone Health & NYU Langone Orthopedic Hospital
  • Innovative Technology System to Prevent Wrong Site Surgery and Capture Near Misses: A Multi-center Review of 487 Cases
    David Gloystein, MD; John Devine, MD; Bradley Heiges, MD; David Schwartz, MD; Deborah Spratt, MPA BSN RN CNOR
  • The Effect of a Transdisciplinary Spine Conference on Quality and Safety for Adult Spinal Deformity Surgery
    Gregory Mundis Jr., MD; Fernando Rios, MD; Hani Malone, MD; Bahar Shahidi, PhD; Tina Iannacone, BSN; Shae Galli, BS; Robert Eastlack, MD

The Safety in Spine Surgery Project is pleased to announce the First Annual Safety in Spine Surgery month, taking place in April of 2021. The goal of this project is to improve safety in spine surgery by sharing guidelines, techniques, and protocols that make care better, and to share lessons learned from participants who have developed specific, successful safety protocols. This event will feature 2 live webinars and an industry-wide social media campaign throughout April.

Under the leadership of Michael G. Vitale, MD, MPH and co-chairmen John Flynn, MD; Roger Härtl, MD; Larry Lenke, MD; Rajiv Sethi, MD, S3P is partnering with surgeons, allied health care providers, organizations, hospitals, and medical device companies in this effort. It is the belief of the program directors that all major healthcare stakeholders are obligated to invest their expertise and funds to enhance patient safety.

Submission of abstracts and projects summaries is underway for Best New Methodologies and Techniques to Enhance Safety in Spine Surgery. The 10 best submissions will each be awarded $1000 and be featured during one of the live webinars. We encourage our colleagues to submit not only scientific papers, but also any project that has made a difference in spine surgery quality, safety, or value. Submissions are due to Kate Laney by February 19, 2021.

Registration is open for two live webinars, taking place April 15 and April 29. The first will focus on predictive analytics, enabling technology, and innovative techniques to make the OR safer. The second will highlight checklists, guidelines, and tricks to avoid complications and improve neurological safety. Registration is free and can be accessed at this link.

We encourage you to get involved in this effort by submitting abstracts, attending the webinars, and getting active on social media during the month of April. Post your successes and difficulties with the hashtags #safetyinspinesurgery and #s3p. Follow us on Twitter, Facebook, Linkedin, and Instagram for further information.

If your practice, organization, or medical device company would like to partner with us, please contact Kate Laney.

We are looking forward to an exciting month of collaboration!

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Save the date for the 5th Annual Safety in Spine Surgery Summit: April 13, 2020 in New York City.

Friday, March 13, 2020
Location: The Heart Conference Center / New York-Presbyterian Hospital, 173 Fort Washington Avenue, New York, NY 10032


  • Michael G. Vitale, MD, MPH


  • John M. Flynn, MD
  • Roger Härtl, MD
  • Rajiv K. Sethi, MD

An ESSENTIAL program for:

  • Spine surgeons
  • Surgical spine team members
  • Hospital execs responsible for patient safety

Registration details will be posted on the Event’s Page.

How Lessons from Cycling Can Inform Efforts at Continuous Improvement

A recent conversation with an avid cycler helped me draw interesting parallels between how sport and the pursuit of skill so often intersects with our mission to make care better in healthcare. Britain’s national efforts in cycling provide such an interesting case study, taking a program who had never won a single gold medal in its 76 year history to winning seven out of 10 gold medals in two consecutive Olympics and applying the same discipline to lead one of the most successful professional cycling teams ever.

Sir Dave Brailsford, the coach responsible for these efforts, took the principles of the Toyota Production System, also called lean, to infuse the team with the spirit of Kaizen, or continuous improvement. He thought that if the team broke down everything they could think of that went into competing better on a bike, and then improved each element by 1%, then these marginal gains could achieve a significant aggregated increase in performance. This came from everything to the traditional areas of experimenting in wind tunnels for aerodynamic, to applying 5S techniques to the mechanics team truck and painting the floor white to prevent slips from grease, to teaching athletes about proper hand hygiene from a surgeon. This even went as far as requiring all athletes to sleep on team provided mattresses and pillows so athletes could sleep in the same posture with the same support every night. Taken together, they felt that it gave a competitive advantage.

These principles of looking at strategy, human performance, and continuous improvement have the same applications to how surgery is performed. For strategy, so much cognitive effort needs to be spent on understanding patient’s unique attributes, understanding plans for surgery, and involving the team. This can also involve slowing down the machine and working with a multidisciplinary team to understand the approach. With S3P efforts, this include recommending using multidisciplinary indications conferences with anesthesia, medicine, and nursing to fully discuss a patient’s treatment plans.

For human performance, this truly involves a surgeon treating themselves as athletes, caring for their physical conditions and optimizing their movements. But this also involves attention to behavioral psychology and creating an environment for optimum performance. This may involve routines the evening and morning before surgery to cognitively rehearse the procedures but also can include preventing heuristic biases from affecting decision making. At S3P, this involves the development of formal risk stratification scores to formalize the requirements and opportunities for “slowing the machine” and optimizing patients’ modifiable risk factors.

The final aspect of continuous improvement plays heavily into Sir Dave’s efforts at finding marginal gains. The same principles are applied within my own OR. For the past year, we have been using the comprehensive unit-based safety program to work with my operative team to fully map out the steps involved in preparing a patient for surgery to incision. From there, we brainstormed ways to drive more efficiencies. Things included marking with tape the position of the table and posting laminated photos of the way the lights should be set up. While each step would only save several minutes at most, as we found more and more opportunities for efficiencies, this began to increase our time to set up by up to 20%. Today, we are applying this across the entire continuum.

Identifying these principles as critical success factors and ensuring they are in place can allow everyone to focus on improvements and reach an optimal place to improve quality, safety, value, throughput and efficiency.