Null Hypothesis: All spinal surgeons in the United Kingdom will routinely use X-ray screening in their practice when performing lumbar spinal surgery.

Background: Surgery at the wrong level fortunately occurs uncommonly in spinal surgical practice. When it occurs it is a potential source of morbidity for the patient and may result in litigation for the surgeon. The authors analysed the intra-operative x-ray practice of UK spinal surgeons at the time of discectomy, decompression and instrumented fusion. They also assessed their views on surgery at the incorrect level and x-ray facilities available in their centres.

Method: 130 members of BASS (British Association of Spinal Surgeons) were sent an anonymous postal questionnaire concerning their practice and views on x-ray use at the time of surgery.

Results: 91(70%) questionnaires were returned. There was a large variation in practice between surgeons. 54 percent of surgeons always used x-ray screening for decompression/discectomy procedures whilst 12 percent only used imaging intermittently. The timing of x-ray screening in relation to opening of the ligamentum flavum was also subject to considerable variation. A small number of surgeons never used x-ray screening for pedicle screw insertion and some only used it occasionally. There was a spectrum of opinion on whether wrong level surgery was substandard practice.

Conclusion: The Null Hypothesis has been disproved. There is a wide spectrum of practice and opinion on intra-operative x-ray practice among UK spinal surgeons. Some comments, suggestions and recommendations are made by the authors.

We report the results of supramalleolar varus osteotomy on seven ankles (in six patients) for haemophilic arthropathy and secondary valgus deformity. The operation reduced pain and the frequency of intra-articular bleeding while preserving joint function for a mean of nine years. The procedure is an attractive alternative to the more commonly used surgical option of arthrodesis.