Radiographic Markers Can Help Locate Spinal Levels

Locating a spine level in the thoracic spine can be challenging, research has shown a novel technique can improve accuracy.

“Preoperative placement of radiopaque markers along with postplacement MRI is a safe and effective method for the confident intraoperative localization of spinal pathology that otherwise would not be visible on intraoperative radiography. There are multiple benefits, including improved reliability and accuracy of localization, minimal discomfort for the patient, and decreased radiation exposure to the patient and operating room personnel,” Richard M. Young, M.D., and colleagues at George Washington University Medical Center in Washington, D.C., wrote in a study.

According to the authors, wrong level spine surgery can be a prevalent problem, with 50 percent of surgeons performing a wrong level surgery at least once in their career.

Young and colleagues presented the use of standard percutaneous techniques and placement of a radiopaque embolization coil into the pedicle of interest under biplanar fluoroscopy in one patient with progressive myelopathy referable to thoracic disc/osteophyte compression at T10-11. They used thoracic spine magnetic resonance imaging (MRI) to perform postplacement along with a scout MRI, which confirmed coil marker placement in relation to the spine pathology prior to surgical intervention.

The scout MRI helped identify some mild scoliosis and confirmed the presence of 14 thoracic vertebrae, counting from the cervical spine down, according to Young and colleagues.

“Following the above technique of preoperative pedicle marking, and performing intraoperative localization via AP [anteroposterior] C-arm fluoroscopy, a T-11 thoracic laminectomy and transpedicular approach was performed to decompress the anterior compression of the spinal cord from the T10–11 disc osteophyte pathology. Through this exposure, the implanted coil was identified and removed, leaving no foreign material in place,” Young and colleagues wrote.

The patient was able to tolerate the pedicle marking and surgical decompression without complications and remains free of symptoms.

This method has an additional cost associated with it, the investigators noted, and a further cost analysis is needed to compare the cost of this procedure to the cost of rare, but expensive, wrong-level surgery events. The technique is an effective and safe way to avoid wrong level spine surgery and can be performed on an outpatient basis to help accurately locate an intraoperative spinal level, according to the researchers.

“Such procedures can be completed in the outpatient setting and take minimal resources and time to perform. It is believed that this is a significant improvement over previously proposed techniques, and, furthermore, it is appropriate for use in a multitude of spinal pathologies,” Young and colleagues wrote.