title: Intraoperative localization of thoracic spine level with preoperative percutaneous placement of intravertebral polymethylmethacrylate.
abstract: OBJECTIVE
  To evaluate the safety and utility of preoperative vertebroplasty for intraoperative localization of thoracic spinal levels.
  
  
  BACKGROUND
  Intraoperative fluoroscopy or plain radiographs are traditionally used to localize thoracic spine levels during thoracic spine operations. Unfortunately, such localization can occasionally be difficult in the midthoracic levels due to lack of landmarks, scapular shadows, and the body habitus of the morbidly obese. There are multiple techniques described in the literature that allow for preoperative localization of thoracic spinal levels during approaches to the posterior thoracic spine. For efficient and accurate intraoperative localization of thoracic spinal levels during anterior thoracic spine procedures, we describe a method that uses preoperative percutaneous placement of polymethylmethacrylate (PMMA) into the vertebral body using standard vertebroplasty technique.
  
  
  METHODS
  Four patients with morbid obesity and symptomatic thoracic disc herniations underwent preoperative vertebroplasty procedures using standard percutaneous techniques. The PMMA cement was used to expeditiously identify thoracic spinal levels of interest using intraoperative fluoroscopy.
  
  
  RESULTS
  All 4 patients underwent successful vertebroplasty procedures without complications. The PMMA cement was easily identified intraoperatively and led to the correct identification of the thoracic spinal levels of interest.
  
  
  CONCLUSIONS
  Preoperative placement of PMMA into thoracic vertebral bodies using standard vertebroplasty technique provides a safe, efficient, and reliable method of localizing thoracic spine levels intraoperatively. Such procedures can be performed in the outpatient setting and can be associated with extremely low morbidity when done by experienced practitioners. This procedure should be reserved for patients in whom a surgeon anticipates difficulty using standard radiographs or fluoroscopy to localize thoracic spinal levels intraoperatively.
authors.affiliation: Department of Neurosurgery, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA. weshsu@jhmi.edu
authors.forename: Wesley
authors.initials: W
authors.lastname: Hsu
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
authors.forename: A Daniel
authors.initials: AD
authors.lastname: Sasson
authors.forename: Yevgeniy
authors.initials: Y
authors.lastname: Khavkin
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Wolinsky
authors.forename: Philippe
authors.initials: P
authors.lastname: Gailloud
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
authors.forename: Kieran
authors.initials: K
authors.lastname: Murphy
mesh_terms: D000328:Adult; D001843:Bone Cements; D017586:Diskectomy / Q000295:instrumentation / Q000379:methods; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000517:prevention & control; D005260:Female; D005471:Fluoroscopy / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007403:Intervertebral Disc / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D007431:Intraoperative Complications / Q000139:chemically induced / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation / Q000379:methods; D009767:Obesity, Morbid / Q000150:complications; D019904:Polymethyl Methacrylate; D011300:Preoperative Care / Q000295:instrumentation / Q000379:methods*; D011856:Radiographic Image Enhancement; D013123:Spinal Fusion / Q000379:methods; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D054854:Vertebroplasty / Q000379:methods*
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate