• Sebastian A Ahmadi, Philipp J Slotty, Catharina Schröter, Patric Kröpil, Hans-Jakob Steiger, and Sven O Eicker.
• Department of Neurosurgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany. Electronic address: ahmadi@med.uni-duesseldorf.de.
• Clin Neurol Neurosurg. 2014 Apr 1;119:100-5.

ObjectiveTo present an innovative approach that does not rely on intraoperative X-ray imaging for identifying thoracic target levels and critically appraise its value in reducing the risk of wrong-level surgery and radiation exposure.Methods96 patients admitted for surgery of the thoracic spine were prospectively enrolled, undergoing a total of 99 marking wire placements. Preoperatively a flexible marking wire derived from breast cancer surgery was inserted with computed tomography (CT) guidance at the site of interest--the wire was then used as an intraoperative guidance tool.ResultsWire placement was considered successful in 96 cases (97%). Most common pathologies were tumors (62.5%) and degenerative disorders (16.7%). Effective doses from CT imaging were significantly higher for wire placements in the upper third of the thoracic spine compared to the lower two thirds (p = 0.015). Radiation exposure to operating room personnel could be reduced by more than 90% in all non-instrumented cases. No adverse reactions were observed, one patient (1.04%) underwent surgical revision due to an epifascial empyema. No wires had to be removed due to lack of patient compliance or infection.ConclusionsThis is a safe and practical approach to identify the level of interest in thoracic spinal surgery employing a marking wire. Its application merits consideration in any spinal case where X-ray localization could prove unsafe, particularly in cases lacking bony pathologies such as intradural tumors.Copyright © 2014 Elsevier B.V. All rights reserved.

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