Marking wire placement for improved accuracy in thoracic spinal surgery

TY - JOUR

T1 - Marking wire placement for improved accuracy in thoracic spinal surgery

AU - Ahmadi, Sebastian A

AU - Slotty, Philipp J

AU - Schröter, Catharina

AU - Kröpil, Patric

AU - Steiger, Hans-Jakob

AU - Eicker, Sven O

N1 - Copyright © 2014 Elsevier B.V. All rights reserved.

PY - 2014

Y1 - 2014

N2 - OBJECTIVE: To present an innovative approach that does not rely on intraoperative X-ray imaging for identifying thoracic target levels and critically appraise its value in reducing the risk of wrong-level surgery and radiation exposure.METHODS: 96 patients admitted for surgery of the thoracic spine were prospectively enrolled, undergoing a total of 99 marking wire placements. Preoperatively a flexible marking wire derived from breast cancer surgery was inserted with computed tomography (CT) guidance at the site of interest--the wire was then used as an intraoperative guidance tool.RESULTS: Wire placement was considered successful in 96 cases (97%). Most common pathologies were tumors (62.5%) and degenerative disorders (16.7%). Effective doses from CT imaging were significantly higher for wire placements in the upper third of the thoracic spine compared to the lower two thirds (p = 0.015). Radiation exposure to operating room personnel could be reduced by more than 90% in all non-instrumented cases. No adverse reactions were observed, one patient (1.04%) underwent surgical revision due to an epifascial empyema. No wires had to be removed due to lack of patient compliance or infection.CONCLUSIONS: This is a safe and practical approach to identify the level of interest in thoracic spinal surgery employing a marking wire. Its application merits consideration in any spinal case where X-ray localization could prove unsafe, particularly in cases lacking bony pathologies such as intradural tumors.

AB - OBJECTIVE: To present an innovative approach that does not rely on intraoperative X-ray imaging for identifying thoracic target levels and critically appraise its value in reducing the risk of wrong-level surgery and radiation exposure.METHODS: 96 patients admitted for surgery of the thoracic spine were prospectively enrolled, undergoing a total of 99 marking wire placements. Preoperatively a flexible marking wire derived from breast cancer surgery was inserted with computed tomography (CT) guidance at the site of interest--the wire was then used as an intraoperative guidance tool.RESULTS: Wire placement was considered successful in 96 cases (97%). Most common pathologies were tumors (62.5%) and degenerative disorders (16.7%). Effective doses from CT imaging were significantly higher for wire placements in the upper third of the thoracic spine compared to the lower two thirds (p = 0.015). Radiation exposure to operating room personnel could be reduced by more than 90% in all non-instrumented cases. No adverse reactions were observed, one patient (1.04%) underwent surgical revision due to an epifascial empyema. No wires had to be removed due to lack of patient compliance or infection.CONCLUSIONS: This is a safe and practical approach to identify the level of interest in thoracic spinal surgery employing a marking wire. Its application merits consideration in any spinal case where X-ray localization could prove unsafe, particularly in cases lacking bony pathologies such as intradural tumors.

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Cohort Studies

KW - Female

KW - Humans

KW - Male

KW - Medical Staff, Hospital

KW - Middle Aged

KW - Prospective Studies

KW - Radiation Injuries

KW - Spinal Cord Diseases

KW - Spinal Diseases

KW - Surgery, Computer-Assisted

KW - Surgical Instruments

KW - Thoracic Vertebrae

KW - Tomography, X-Ray Computed

KW - Young Adult

U2 - 10.1016/j.clineuro.2014.01.025

DO - 10.1016/j.clineuro.2014.01.025

M3 - SCORING: Journal article

C2 - 24635936

VL - 119

SP - 100

EP - 105

JO - CLIN NEUROL NEUROSUR

JF - CLIN NEUROL NEUROSUR

SN - 0303-8467

ER -