Marking wire placement for improved accuracy in thoracic spinal surgery

Ahmadi, Sebastian A.; Slotty, Philipp J.; Schröter, Catharina; Kröpil, Patric; Steiger, Hans‐Jakob; Eicker, Sven Oliver

doi:10.1016/j.clineuro.2014.01.025

Cited by 5 publications

(2 citation statements)

References 25 publications

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“…In a proposed technique by Ahmadi et al, a marking wire derived from breast cancer surgery was inserted percutaneously under CT guidance preoperatively to mark the appropriate surgical level, using the same techniques for placement of fiducial metallic markers or metallic coils. 22 The difference with this technique is that the marking wire is tunneled out through the skin. The authors analyzed 96 patients undergoing surgery of the thoracic spine, predominately for tumor resection, with successful wire placement and utilization in 93 (97%) of the 96 patients.…”

Section: Preoperative Percutaneous Placement Of a Marking Wirementioning

confidence: 99%

“…The authors concluded that this method was safe but that some nuances made it technically challenging. 22 Preoperative Percutaneous Placement of PMMA First described in 2008 by Hsu et al, percutaneous placement of PMMA is a straightforward technique for localization within the thoracic spine that can be performed on an outpatient basis. 23 Briefly, after review of the diagnostic studies and confirmation of the correct level, the patient is brought back to the radiology interventional suite, placed prone on a table, and undergoes biplanar fluoroscopy.…”

Section: Preoperative Percutaneous Placement Of a Marking Wirementioning

confidence: 99%

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Pre- and intraoperative thoracic spine localization techniques: a systematic review

Strong

Santarosa²,

Sullivan

et al. 2022

Journal of Neurosurgery: Spine

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OBJECTIVE In the era of modern medicine with an armamentarium full of state-of-the art technologies at our disposal, the incidence of wrong-level spinal surgery remains problematic. In particular, the thoracic spine presents a challenge for accurate localization due partly to body habitus, anatomical variations, and radiographic artifact from the ribs and scapula. The present review aims to assess and describe thoracic spine localization techniques. METHODS The authors performed a literature search using the PubMed database from 1990 to 2020, compliant with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A total of 27 articles were included in this qualitative review. RESULTS A number of pre- and intraoperative strategies have been devised and employed to facilitate correct-level localization. Some of the more well-described approaches include fiducial metallic markers (screw or gold), metallic coils, polymethylmethacrylate, methylene blue, marking wire, use of intraoperative neuronavigation, intraoperative localization techniques (including using a needle, temperature probe, fluoroscopy, MRI, and ultrasonography), and skin marking. CONCLUSIONS While a number of techniques exist to accurately localize lesions in the thoracic spine, each has its advantages and disadvantages. Ultimately, the localization technique deployed by the spine surgeon will be patient-specific but often based on surgeon preference.

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Section: Preoperative Percutaneous Placement Of a Marking Wirementioning

confidence: 99%

Section: Preoperative Percutaneous Placement Of a Marking Wirementioning

confidence: 99%

Pre- and intraoperative thoracic spine localization techniques: a systematic review

Strong

Santarosa²,

Sullivan

et al. 2022

Journal of Neurosurgery: Spine

View full text Add to dashboard Cite

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Preventing Wrong-Level Spine Surgery

Agolia,

Robertson,

Turel

et al. 2024

Acta Neurochirurgica Supplement

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Importance: Wrong-level spine surgery (WLSS), a medical error in which a surgeon operates at an unintended vertebral level, is considered a “never event.” However, it continues to be a problem in spine surgery today despite the implementation of preventive measures such as the Universal Protocol. The consequences of this event are severe for both the afflicted patient and the treating physician and may result not only in physical harm but also in costly medicolegal proceedings.Observations: While WLSS incidence varies with the patient population and practice setting, large studies generally report rates below 1%. Given the ubiquity of spine surgery, this remains a concerning number. Risk factors for WLSS can be categorized into three domains: patient factors, imaging issues, and technical issues. Awareness of risk factors allows surgeons to plan for difficulties in level localization. Many techniques for preventing WLSS have been developed, including invasive preoperative marking strategies. Intraoperative radiography or fluoroscopy is necessary but not sufficient for WLSS prevention, in that many errors occur after imaging. The evidence for prevention methods remains of low quality, necessitating future prospective comparison studies.Conclusions and relevance: Consensus has been reached in professional societies: All spine surgeons should implement WLSS prevention protocols. We assess the reported techniques for safer surgery and emphasize one crucial time-out element: the time-out for level localization (TOLL). Addressing WLSS as a problem specific to spine surgery, we show that by using specially tailored prevention strategies, such measures will allow WLSS to become a true never event.

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