gms | German Medical Science

Objective: Identifying the level of interest in thoracic spinal surgery can be a significant challenge to the surgeon. Operating at wrong levels not only results in additional surgery with all its inherent risks but also usually leads to costly litigation. To date, most institutions rely on intraoperative x-ray imaging to properly identify target levels. At thoracic levels especially identification of specific vertebral bodies can be suboptimal due to the unique anatomy and structure of the thoracic spine. Our objective was to present an innovative approach and critically appraise its value in reducing the risk of wrong-level surgery.

Methods: Preoperatively a flexible hooked wire needle derived from breast cancer surgery was inserted under computed tomography (CT-) guidance at the site of interest – the wire was then used as an intraoperative guidance tool. A historical case of wrong-level surgery is presented and discussed.

Results: We employed this technique in 10 consecutive patients. On postoperative CT imaging all cases showed accurate-level placement of instrumentation. No adverse reactions and no post-operative infections were observed in this series. Patients reported some minor discomfort on insertion but no wires had to be removed due to lack of patient compliance.

Conclusions: We hereby demonstrated a safe and practical approach to identify the level of interest in thoracic spinal surgery employing a flexible hooked wire. Its application is not limited to thoracic surgery but merits consideration in any spinal case where x-ray localization could be impeded.