Wrong-site spine surgery is an adverse event that has potentially devastating consequences for the patient as well as the surgeon. Despite substantial efforts to prevent wrong-site spine surgery, this complication continues to occur and has the potential for serious medical, personal, and legal repercussions. Although systems-based prevention methods are effective in identifying the proper patient, procedure, and region of the spinal column, they cannot be relied on to establish the correct vertebral level during the operation. The surgeon must design and implement a patient-specific protocol to ensure that the appropriate operation is performed on the correct side and level or levels of the spinal column.