Spinous process marking: a reliable method for preoperative surface localization of intradural lesions of the high thoracic spine

Paolini, Sergio; Ciappetta, Pasqualino; Missori, Paolo; Raco, Antonino; Delfini, Roberto

doi:10.1080/02688690500089209

Cited by 58 publications

(31 citation statements)

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“…Several invasive and noninvasive methods for appropriate localization have been described, along with their advantages and disadvantages, in the literature. 3,10,12 We recently described the use of cod liver oil capsules in the preoperative MRI localization of intradural tumors, which resulted in a 97% accuracy rate, and we feel comfortable using this technique. Our method of localization is safe and accurate and prevents the need for intraoperative fluoroscopy because it is based on the principle of visualizing the intradural pathology, which eliminates the need to correlate the level with the bony anatomy.…”

Section: Discussion Preoperative Localization Of Tumorsmentioning

confidence: 99%

Hemilaminectomy approach for intradural extramedullary spinal tumors: an analysis of 164 patients

Turel¹,

D'Souza²,

Rajshekhar³

2015

FOC

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OBJECT The authors report their experience with the use of a minimally invasive hemilaminectomy approach for the excision of intradural extramedullary (IDEM) tumors of the spinal cord. METHODS Included were 164 consecutive patients (167 tumors in total), treated between January 2004 and December 2014, in whom the hemilaminectomy approach for IDEM spinal cord tumors was planned. The clinicoradiological data of patients presenting to Christian Medical College were analyzed retrospectively using a computerized chart-review method. Preoperative MRI localization was used in 51 cases. RESULTS The mean age (± SD) of the patients was 42.6 ± 16.6 years, and the mean duration of symptoms was 20.8 ± 27.8 months. The average tumor size was 2.4 ± 1.7 cm. Forty-four tumors were cervical, 5 were cervicothoracic, 72 were thoracic, 7 were thoracolumbar, and 39 were lumbar. Forty-two tumors were ventrally located, whereas 11 were ventrolateral; the rest were either dorsal or dorsolateral. The most common pathologies were schwannoma (110 cases) and meningioma (31 cases). Total excision was achieved for 93% of the tumors. The average duration of surgery was 1.6 ± 0.6 hours. CONCLUSIONS The hemilaminectomy approach to the removal of intradural tumors was quick and safe and resulted in minimal morbidity and no mortality. Preoperative MRI localization improved accuracy and reduced operating time by eliminating the need for intraoperative fluoroscopy.

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Section: Discussion Preoperative Localization Of Tumorsmentioning

confidence: 99%

Hemilaminectomy approach for intradural extramedullary spinal tumors: an analysis of 164 patients

Turel¹,

D'Souza²,

Rajshekhar³

2015

FOC

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“…Various techniques have been described for localization in the thoracic spine. 8,13,14,18 We sought to determine if the preoperative placement of a fiducial marker screw for spinal localization was a safe and effective method of preventing wrong-level surgery.…”

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confidence: 99%

Avoidance of wrong-level thoracic spine surgery: intraoperative localization with preoperative percutaneous fiducial screw placement

Upadhyaya

Chin

et al. 2012

SPI

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Object The accurate intraoperative localization of the correct thoracic spine level remains a challenging problem in both open and minimally invasive spine surgery. The authors describe a technique of using preoperatively placed percutaneous fiducial screws to localize the area of interest in the thoracic spine, and they assess the safety and efficacy of the technique. Methods To avoid wrong-level surgery in the thoracic spine, the authors preoperatively placed a percutaneous 5-mm fiducial screw at the level of intended surgery using CT guidance. Plain radiographs and CT images with reconstructed views can then be referenced in the operating room to verify the surgical level, and the fiducial screw is easily identified on intraoperative fluoroscopy. The authors compared a group of 26 patients who underwent preoperative (often outpatient) fiducial screw placement prior to open or minimally invasive thoracic spine surgery to a historical group of 26 patients who had intraoperative localization with fluoroscopy alone. Results In the treatment group of 26 patients, no complications related to fiducial screw placement occurred, and there was no incidence of wrong-level surgery. In comparison, there were no wrong-level surgeries in the historical cohort of 26 patients who underwent mini-open or open thoracic spine surgery without placement of a fiducial screw. However, the authors found that the intraoperative localization fluoroscopy time was greatly reduced when a fiducial screw localization technique was employed. Conclusions The aforementioned technique for intraoperative localization is safe, efficient, and accurate for identifying the target level in thoracic spine exposures. The fiducial marker screw can be placed using CT guidance on an outpatient basis. There is a reduction in the amount of intraoperative fluoroscopy time needed for localization in the fiducial screw group.

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“…A number of techniques have been described in the literature to reduce the incidence of wrong level surgery. [2,3,[5][6][7][8][9][10][11][12][13]. Fluoroscopy has been successfully used for intraoperative localisation of cervical and lumbar spine levels by counting the bony landmarks.…”

Section: Discussionmentioning

confidence: 99%

“…However, the skin being mobile can shift the marker and lose position of the correct level. Pre-operative injection of dye [6,7] has also been described as a method to identify spine levels, but for posterior spinal surgery only. Others have performed pre-operative localisation of thoracic spine level in disc surgery by placing coils at or near the pedicle of interest [3,10].…”

Section: Discussionmentioning

confidence: 99%

Intra-operative localisation of thoracic spine level: a simple “‘K’-wire in pedicle” technique

Thambiraj

Quraishi

2012

Eur Spine J

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Purpose of study To describe a simple and reliable method of intra-operative localisation of thoracic spine in a single surgical setting. Summary of background Intra-operative localisation of thoracic spine levels can be difficult due to anatomical constraints, such as scapular shadow, patient's size and poor bone quality. This is particularly true in cases of thoracic discectomies in which the vertebral bodies appear normal. There are several methods described in recent literature to address this. Many of them require a separate procedure which was performed often the previous day. We report a technique which addresses the issue of localising thoracic level intra-operatively. Materials and methods After induction of general anaesthesia, the patient was placed prone and the pedicle of interest was identified using fluoroscopy. A K-wire was then inserted percutaneously into this pedicle under image guidance [confirmed in the antero-posterior (AP) and lateral views]. The wire was then cut close to the skin after bending it. The patient was now positioned laterally and the intended procedure performed through an anterior trans-thoracic approach. The 'K' wire was removed at the end of the procedure. Results and conclusion We routinely used this technique in all our thoracic discectomies (four cases in 2 years). There were no intra-operative complications. This method is simple, avoids the patient undergoing two procedures and requires no more ability than placing an implant in the pedicle under fluoroscopy. Placing the 'K' wire into a fixed point like the pedicle facilitates rapid intra-operative viewing of the level of interest and is removed easily at the conclusion of surgery.

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Spinous process marking: a reliable method for preoperative surface localization of intradural lesions of the high thoracic spine

Cited by 58 publications

References 1 publication

Hemilaminectomy approach for intradural extramedullary spinal tumors: an analysis of 164 patients

Hemilaminectomy approach for intradural extramedullary spinal tumors: an analysis of 164 patients

Avoidance of wrong-level thoracic spine surgery: intraoperative localization with preoperative percutaneous fiducial screw placement

Intra-operative localisation of thoracic spine level: a simple “‘K’-wire in pedicle” technique

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