New Thoracic Spine Surgery Technique Helps Avoid Operating on the Wrong Level

Although it does not happen often, nearly 50 percent of spine surgeons perform surgery on the wrong level of the spine at some point in their career. A variety of factors — such as obesity, osteoporosis and anatomical variations in the number of rib-bearing vertebra or the distance between traditional spinal landmarks — make it difficult to localize a precise operative site in the thoracic spine. To avoid surgery on the wrong vertebral level, a successful new technique is proposed in an article in the Journal of Neurosurgery: Spine, now available online; click here to read it.

In the article “Avoidance of wrong-level thoracic spine surgery: intraoperative localization with preoperative percutaneous fiducial screw placement,” Upadhyaya and colleagues describe a technique involving percutaneous placement of a fiducial screw in a specific thoracic vertebra to localize the appropriate operative site. Insertion of this minute screw is performed using computed tomography (CT) guidance and can be done preoperatively on an outpatient basis. On the day of the operation, radiographs or reconstructed CT scans can be referenced to confirm the operative level. The screw can be visualized intraoperatively using fluoroscopy. In this paper, the authors assess the safety and efficacy of using a fiducial screw to guide appropriate-level surgery, and compare its use with intraoperative fluoroscopy alone and a variety of other localization techniques discussed in the literature. Click here to read the full release.