In a further effort to minimise the risk of performing wrong level surgery in the spine it is proposed that after each x-ray is taken that the surgeon discusses with the theatre team the findings from the x-ray and how this will influence the operation. This needs to be said aloud to the anaesthetist, the registrar, the radiographer or scrub nurse but the ultimate responsibility for correct level surgery remains with the surgeon. It is thought that by vocalising the thoughts created by looking at the x-ray that this will then engender a check with the pre-operative scan and allow the information to correctly influence the forthcoming operation. It is the formalisation and verbalisation of this thought process that will enable the full focus of the theatre team to ensure that correct level surgery is performed. This could then be recorded on the WHO checklist. An x-ray with a marker in the correct disc space is not essential as long as the surgeon makes the correct adjustments based on the intra-operative x-ray available.