Percutaneous Placement of Radiopaque Markers at the Pedicle of Interest for Preoperative Localization of Thoracic Spine Level

In Brief Study Design. Retrospective review. Objective. To describe an accurate method of intraoperative localization of thoracic spine levels with percutaneously placed radiopaque markers at the pedicle of the level of interest. Summary of Background Data. Intraoperative localization of thoracic spine levels can be difficult in cases without obvious vertebral body deformation (compression fracture, tumor), such as thoracic discectomy, as well as in surgery of the midthoracic spine and in the morbidly obese. Intraoperative fluoroscopy or plain radiographs are useful but can often be difficult to interpret in these cases. Methods. Fourteen patients requiring anterior thoracic spine surgery for thoracic disc herniations underwent preoperative localization and placement of radiopaque marker. Using standard percutaneous techniques, the radiopaque markers were placed using biplanar fluoroscopy at the pedicle at the level of interest. Eight patients subsequently underwent thoracoscopic discectomy and fusion, and 6 patients underwent mini-open thoracotomy for discectomy and fusion. Results. Placement of radiopaque markers was successfully completed without complications in all 14 patients. Intraoperatively, the markers were easy to identify and assisted in identification of the correct surgical level in all cases. Conclusion. Preoperative placement of radiopaque markers at the level of interest before surgery of the thoracic spine is a safe and effective technique for avoiding wrong-level surgery in cases in which standard localization techniques may be difficult. Localization of the level of interest in thoracic disc surgery can be difficult in certain patients. Prolonged surgery and wrong level surgery can result if localization is not correct. The authors describe an effective and safe method of preoperative localization of the level of interest with a radiopaque marker to aid in visualization of the correct level during thoracic discectomy and fusion.