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Safety in Spine Surgery Project – S3P

Save the Date for the 9th Annual Safety in Spine Surgery Summit | May 31, 2024



Safety in Spine Surgery Summit:

Chairman: Michael Vitale, MD

Course Co-Chairs: Lawrence G. Lenke, MD; Rajiv Sethi, MD

Course Directors: Philip Louie, MD; A. Noelle Larson, MD

Location: The Heart Conference Center / New York-Presbyterian Hospital, New York, NY

Join an expert faculty for a fresh look at optimizing safety in spine surgery! We’ll explore new topics such as:

  • How Can Enabling Technologies Improve Outcomes?
  • Avoiding Complications with New Techniques

Plus, bring your whole care team for discussions on:

  • Building and Maintaining an Expert OR Staff
  • Collaborating with the Next Generation


History of The Safety in Spine Surgery Project

Dr. Vitale founded The Safety in Spine Surgery Project (S3P) in 2016 to help improve safety in spine surgery across the nation. The mission of S3P is to identify ways to enhance the safety and sustainability of spine surgery and work with stakeholders in spine surgery, including but not limited to patients, providers, payers, and purchasers, to prevent harm. S3P hosts the annual Spine Safety Summit which brings spine surgeons from around the world to New York to learn about the latest ways to improve culture, create dedicated teams, and follow best practices to make spine surgery safe.

Dr. Derek Lee interviews Dr. Michael Vitale about Safety in Spine Surgery Month. Learn about the inspiration for founding the Safety in Spine Surgery Project (S3P) and the impact the organization has had already.


Founded and directed by the Safety in Spine Surgery Project (S3P), and chaired by Michael Vitale, MD, 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 developed specific, successful safety protocols.

This will be accomplished by the partnership of S3P with surgeons, medical professionals, medical device companies, and hospitals.

Over time the S3P project will help improve the statistics showing high numbers of medical and surgical errors that have recently been highlighted by US government agencies, medical societies, patient groups, and throughout the media. These errors cause unnecessary human suffering, damage the reputation of the medical community, and dramatically increase costs.

Learn More & Get Involved

Contribute your expertise and learn more to enhance safety in spine surgery!

1. Attend a Live Webinar in April—Read More

2. Get Your Company Involved

3. Follow Us on Social Media and Be a Part of the Conversation

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8th Annual Safety in Spine Surgery Summit Videos

Learn from our faculty at the 2023 Safety in Spine Surgery Summit in these recorded videos.

April 15, 2023 | New York, New York

View the videos from the Safety Summit at the link below.


Safety in Spine Surgery—Complete Video Library


More about S3P


Spine Surgery is a necessary, beneficial, and cost-effective intervention1,2. However, every year an estimated 60,000 patients are harmed in the course of Spine Surgery3-7. The S3P vision is to reduce the number of patients harmed during and after spine surgery by 50%, from 60,000 to 30,000 by 2023. Preventing harm would generate up to $1 billion in savings to society.

S3P plans on doing this by the following initiatives:

  1. Improving Quality and Reliability
    • Promoting the use of checklists to adhere to best practice guidelines including
      • Preventing surgical site infection
        1. Preventing Surgical Site Infection can generate up to $180,000 in healthcare savings9. Achieving this goal would yield up to $600,000,000 in savings to society.
      • Preventing wrong-level spine surgery
        1. Median malpractice claims associated with wrong-level spine surgery are $75,00011. Achieving this goal would yield up to $45,000,000 in savings to society.
      • Responding to changes in intraoperative neuromonitoring
        1. Median malpractice claims associated with intraoperative neurological injury are $250,000.11 Achieving this goal would yield up to $225,000,000 in savings.
    • Promoting the use of dedicated spine teams across the episode of care
    • Promoting shared decision making with providers and patients through the development and use of educational materials and patient-specific risk severity scores: Use of patient decision aids is associated with 21% reduction in deciding on invasive approaches13
      • Median malpractice claims associated with patient dissatisfaction with final outcomes of surgery are $140,000.13
  2. Preventing unnecessary utilization: Reducing the total number of spine surgeries and avoidable readmissions can prevent overall harm from surgery-related complications and reduce low-value care
    • Ensuring patients are strong enough for surgery through development of framework for implementing risk screening and modifiable risk factor optimization pathways in surgical practices
    • Developing and identifying a network of centers of excellence to deliver reliable and predictable outcomes and costs
      • Certification of providers dedicated to quality and safety
    • Development of payment model frameworks focused on structure, process, and outcomes for working with healthcare stakeholders such as payers, purchasers and malpractice insurers
  3. Advocating for adoption of best practices in spine surgery with stakeholders
    • Promoting standards for quality, safety, and utilization within national societies
    • Promoting the adoption of centers of excellence and payment models with purchasers and payers


  1. Paulus MC, Kalantar SB, Radcliff K. Cost and value of spinal deformity surgery. Spine (Phila Pa 1976). 2014;39(5):388-393. doi:10.1097/BRS.0000000000000150.
  2. McCarthy I, O’Brien M, Ames C, et al. Incremental cost-effectiveness of adult spinal deformity surgery: observed quality-adjusted life years with surgery compared with predicted quality-adjusted life years without surgery. Neurosurg Focus. 2014;36(5):E3. doi:10.3171/2014.3.FOCUS1415.
  3. Lam SK, Pan I-W, Harris DA, Sayama CM, Luerssen TG, Jea A. Patient-, procedure-, and hospital-related risk factors of allogeneic and autologous blood transfusion in pediatric spinal fusion surgery in the United States. Spine (Phila Pa 1976). 2015;40(8):560-569. doi:10.1097/BRS.0000000000000816.
  4. Rajaee SS, Bae HW, Kanim LEA, Delamarter RB. Spinal fusion in the United States: analysis of trends from 1998 to 2008. Spine (Phila Pa 1976). 2012;37(1):67-76. doi:10.1097/BRS.0b013e31820cccfb.
  5. Reames DL, Smith JS, Fu K-MG, et al. Complications in the surgical treatment of 19,360 cases of pediatric scoliosis: a review of the Scoliosis Research Society Morbidity and Mortality database. Spine (Phila Pa 1976). 2011;36(18):1484-1491. doi:10.1097/BRS.0b013e3181f3a326.
  6. Smith JS, Fu K-MG, Polly DW, et al. Complication rates of three common spine procedures and rates of thromboembolism following spine surgery based on 108,419 procedures: a report from the Scoliosis Research Society Morbidity and Mortality Committee. Spine (Phila Pa 1976). 2010;35(24):2140-2149. doi:10.1097/BRS.0b013e3181cbc8e7.
  7. Fu K-MG, Smith JS, Polly DW, et al. Morbidity and mortality associated with spinal surgery in children: a review of the Scoliosis Research Society morbidity and mortality database. J Neurosurg Pediatr. 2011;7(1):37-41. doi:10.3171/2010.10.PEDS10212.
  8. Haynes AB, Weiser TG, Berry WR, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;360(5):491-499. doi:10.1056/NEJMsa0810119.
  9. Emohare O, Ledonio CG, Hill BW, Davis RA, Polly DW, Kang MM. Cost savings analysis of intrawound vancomycin powder in posterior spinal surgery. Spine J. 2014;14(11):2710-2715. doi:10.1016/j.spinee.2014.03.011.
  10. Vitale M, Minkara A, Matsumoto H, et al. Building Consensus: Development of Best Practice Guidelines on Wrong Level Surgery in Spinal Deformity. Spine Deform. 2018;6(2):121-129. doi:10.1016/j.jspd.2017.08.005.
  11. Matsen FA, Stephens L, Jette JL, Warme WJ, Posner KL. Lessons Regarding the Safety of Orthopaedic Patient Care. J Bone Jt Surgery-American Vol. 2013;95(4):e20-1-8. doi:10.2106/JBJS.K.01272.
  12. Sansur CA, Smith JS, Coe JD, et al. Scoliosis research society morbidity and mortality of adult scoliosis surgery. Spine (Phila Pa 1976). 2011;36(9):E593-7. doi:10.1097/BRS.0b013e3182059bfd.
  13. Stacey D, Légaré F, Col NF, et al. Decision aids for people facing health treatment or screening decisions. Cochrane database Syst Rev. 2014;(1):CD001431. doi:10.1002/14651858.CD001431.pub4.
  • Quality tools are a public good that should be shared widely and freely
  • Safety is a science using rigorous methods from the fields of health services research and implementation science
  • Tools are not enough to produce change. Culture change is critical.