A novel device to simplify intraoperative radiographic visualization of the cervical spine by producing transient caudal shoulder displacement: a 2-center case series of 80 patients

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  • 1 School of Medicine, University of Manitoba, Winnipeg, Manitoba;
  • 5 Division of Neurosurgery, St. Michael's Hospital, Labatt Family Centre of Excellence in Brain Injury and Trauma Research, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto;
  • 6 Department of Surgery, University of Toronto, Ontario, Canada;
  • 2 Section of Neurosurgery, Condell Medical Center, Libertyville;
  • 3 Section of Neurosurgery, Lake Forest Hospital, Lake Forest; and
  • 4 Section of Neurosurgery, University of Chicago Hospitals, Chicago, Illinois
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Intraoperative radiographic localization within the cervical spine can be a challenge because of the anatomical relation of the musculoskeletal structures of the pectoral girdle. On standard cross-table lateral radiographs, these structures can produce shadowing that obscure the anatomical features of the cervical vertebrae, particularly at the caudal levels. Surgical guidelines recommend accurate intraoperative localization as a means to reduce wrong-level spine surgery, and unobstructed visualization is needed for fluoroscopy-guided placement of spinal instrumentation. In this article, the authors describe and evaluate a novel device designed to provide transient intraoperative caudal displacement of the shoulders to improve and simplify radiographic visualization of the cervical spine.


A 2-center prospective study was conducted to evaluate the device. The study included a total of 80 patients undergoing cervical spine surgery. The device was evaluated in a cohort of 50 patients undergoing elective single-level anterior discectomy and fusion and also in a second cohort of 30 patients at an independent institution. The patients in this second cohort were undergoing a variety of cervical spine procedures for multiple indications and were included in the study to allow the authors to assess the effectiveness of the device in a general neurosurgical practice. After the patients were anesthetized and positioned, consecutive standard cross-table lateral radiographs or intraoperative fluoroscopic were obtained before and after use of the device. The images were compared in order to determine the difference in lowest vertebral level visible.


There was an average difference in cervical spine visualization of +2.8 ± 0.9 vertebral levels in the first cohort, while in the second the improvement was +1.2 ± 0.7 levels (p < 0.0001 between cohorts, unpaired t-test). There was one complication, a minor shoulder abrasion, which required no specific management.


This device is safe and effective for increasing the radiographic visualization of the cervical spine for intraoperative localization.

Abbreviation used in this paper:CCV = Citow Cervical Visualizer.

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Contributor Notes

Address correspondence to: R. Loch Macdonald, M.D., Ph.D., Division of Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada M5B 1W8. email: MacdonaldLo@smh.ca.

Please include this information when citing this paper: published online October 4, 2013; DOI: 10.3171/2013.9.SPINE11998.

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