Preoperative coil localization for spinal surgery: technical note

Restricted access

Intraoperative localization in spinal surgery is essential to facilitate the best surgical outcome and to avoid wrong-site surgery. Intraoperative fluoroscopy is generally adequate, but anatomical variation, body habitus, and the inherent difficulties of fluoroscopy at certain levels may lead the surgeon astray. Here, the authors present their technique for preoperative localization that relies solely on fixed anatomical landmarks using CT-guided, percutaneously placed radiopaque markers. In the outpatient setting, low-dose CT scanning of the neuraxis is performed to identify fixed landmarks and, under local anesthesia and CT guidance, a pushable microcoil is inserted through a Chiba needle into the periosteum of the pedicle at the level of interest. The patient returns home with no precautions while the coil is in situ, and then the patient returns sometime later for surgery. Intraoperatively, typically a single lateral radiograph is required to visualize the coil and the level. Preoperative placement of radiopaque markers at the level of interest is an effective tool for avoiding wrong-site surgery, especially in circumstances in which fluoroscopy may be troublesome. The authors’ method is accurate, effective, and expeditious and can be performed easily in the outpatient setting.

Article Information

Contributor Notes

Correspondence Mendel Castle-Kirszbaum: Monash Health, Melbourne, Australia. mendel.dck@gmail.com.INCLUDE WHEN CITING Published online November 15, 2019; DOI: 10.3171/2019.8.SPINE19762.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
Headings
References
  • 1

    Ammerman JMAmmerman MDDambrosia JAmmerman BJ: A prospective evaluation of the role for intraoperative x-ray in lumbar discectomy. Predictors of incorrect level exposure. Surg Neurol 66:4704742006

    • Search Google Scholar
    • Export Citation
  • 2

    Binning MJSchmidt MH: Percutaneous placement of radiopaque markers at the pedicle of interest for preoperative localization of thoracic spine level. Spine (Phila Pa 1976) 35:182118252010

    • Search Google Scholar
    • Export Citation
  • 3

    Childers CPMaggard-Gibbons M: Understanding costs of care in the operating room. JAMA Surg 153:e1762332018

  • 4

    Dietrich TJPeterson CKZeimpekis KGBensler SSutter RPfirrmann CWA: Fluoroscopy-guided versus CT-guided lumbar steroid injections: comparison of radiation exposure and outcomes. Radiology 290:7527592019

    • Search Google Scholar
    • Export Citation
  • 5

    Glass RBJNorton KIMitre SAKang E: Pediatric ribs: a spectrum of abnormalities. Radiographics 22:871042002

  • 6

    Groff MWHeller JEPotts EAMummaneni PVShaffrey CISmith JS: A survey-based study of wrong-level lumbar spine surgery: the scope of the problem and current practices in place to help avoid these errors. World Neurosurg 79:5855922013

    • Search Google Scholar
    • Export Citation
  • 7

    Hsu WSciubba DMSasson ADKhavkin YWolinsky JPGailloud P: Intraoperative localization of thoracic spine level with preoperative percutaneous placement of intravertebral polymethylmethacrylate. J Spinal Disord Tech 21:72752008

    • Search Google Scholar
    • Export Citation
  • 8

    Jhawar BSMitsis DDuggal N: Wrong-sided and wrong-level neurosurgery: a national survey. J Neurosurg Spine 7:4674722007

  • 9

    Kim MHLee ASMin SHYoon SH: Risk factors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty. Asian Spine J 5:1801872011

    • Search Google Scholar
    • Export Citation
  • 10

    Mayer JEDang RPDuarte Prieto GFCho SKQureshi SAHecht AC: Analysis of the techniques for thoracic- and lumbar-level localization during posterior spine surgery and the occurrence of wrong-level surgery: results from a national survey. Spine J 14:7417482014

    • Search Google Scholar
    • Export Citation
  • 11

    Mody MGNourbakhsh AStahl DLGibbs MAlfawareh MGarges KJ: The prevalence of wrong level surgery among spine surgeons. Spine (Phila Pa 1976) 33:1941982008

    • Search Google Scholar
    • Export Citation
  • 12

    Paolini SCiappetta PMissori PRaco ADelfini R: Spinous process marking: a reliable method for preoperative surface localization of intradural lesions of the high thoracic spine. Br J Neurosurg 19:74762005

    • Search Google Scholar
    • Export Citation
  • 13

    Sharr MMWeller ROBrice JG: Spinal cord necrosis after intrathecal injection of methylene blue. J Neurol Neurosurg Psychiatry 41:3843861978

    • Search Google Scholar
    • Export Citation
  • 14

    Tubbs RSShoja MMLoukas M: Bergman’s Comprehensive Encyclopedia of Human Anatomic Variation. Hoboken, NJ: John Wiley & Sons2016

TrendMD
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 579 579 579
Full Text Views 39 39 39
PDF Downloads 30 30 30
EPUB Downloads 0 0 0
PubMed
Google Scholar