• Mandy J Binning and Meic H Schmidt.
• Department of Neurosurgery, University of Utah, Salt Lake City, UT 84132, USA.
• Spine. 2010 Sep 1; 35 (19): 1821-5.

Study DesignRetrospective review.ObjectiveTo 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 DataIntraoperative 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.MethodsFourteen 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.ResultsPlacement 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.ConclusionPreoperative 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.

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