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Introduction: The number of cases of patient injuries in the Danish Hospital Adminstration has been increasing throughout the last decade. The purpose of our investigation was to evaluate how many operations were performed at an incorrect level in patients with lumbar disc prolapse and to focus on the prevention of damage in lumbar surgery. Materials and Methods: During the years 1996-2000, thirty-six patients who underwent an operation for lumbar disc prolapse at an incorrect level were identified by the Danish Hospital Adminstration. The data were compared to the Danish National Board of Health's National Patient Registry, which includes all such operations performed and from which the rate of incorrect level of operation and the risk of injury could be calculated. Results: In nearly all patients the lumbar disc prolapse was located in the fourth or fifth disc space. Nineteen of the patients were not evaluated with perioperative X-ray, and the level was determined from anatomical landmarks. Seventeen patients were - in spite of the use of perioperative X-ray - operated on at an unintended level. Most of the patients were operated on at a level cranial to the expected level. During the period 1998-2000, 12,707 lumbar operations were done in Denmark, and the 19 operations from that period examined by the Danish Hospital Adminstration indicate a risk of 1.5 per thousand, but with great regional differences. Discussion: The present data do not confirm that perioperative X-ray is of any help, but common sense suggests that modern X-ray techniques, combined with the operative skills of the surgeon and his knowledge of the patient, strongly enhance the safety of these operations. The real risk for an operation at an unintended level is thus not very high but is prob-ably greater that the present 1.5 cases per thousand.

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