title: Intra-operative localisation of thoracic spine level: a simple "'K'-wire in pedicle" technique.
abstract: OBJECTIVE
  To describe a simple and reliable method of intra-operative localisation of thoracic spine in a single surgical setting. Intra-operative localisation of thoracic spine levels can be difficult due to anatomical constraints, such as scapular shadow, patient's size and poor bone quality. This is particularly true in cases of thoracic discectomies in which the vertebral bodies appear normal. There are several methods described in recent literature to address this. Many of them require a separate procedure which was performed often the previous day. We report a technique which addresses the issue of localising thoracic level intra-operatively.
  
  
  METHODS
  After induction of general anaesthesia, the patient was placed prone and the pedicle of interest was identified using fluoroscopy. A K-wire was then inserted percutaneously into this pedicle under image guidance [confirmed in the antero-posterior (AP) and lateral views]. The wire was then cut close to the skin after bending it. The patient was now positioned laterally and the intended procedure performed through an anterior trans-thoracic approach. The 'K' wire was removed at the end of the procedure.
  
  
  CONCLUSIONS
  We routinely used this technique in all our thoracic discectomies (four cases in 2 years). There were no intra-operative complications. This method is simple, avoids the patient undergoing two procedures and requires no more ability than placing an implant in the pedicle under fluoroscopy. Placing the 'K' wire into a fixed point like the pedicle facilitates rapid intra-operative viewing of the level of interest and is removed easily at the conclusion of surgery.
authors.affiliation: Centre for Spine Studies and Surgery, Queen's Medical Centre, Nottingham, UK. sathyathambiraj@gmail.com
authors.forename: Sathya
authors.initials: S
authors.lastname: Thambiraj
authors.forename: Nasir A
authors.initials: NA
authors.lastname: Quraishi
mesh_terms: D000328:Adult; D000368:Aged; D019299:Decompression, Surgical / Q000295:instrumentation / Q000379:methods; D017586:Diskectomy / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome