title: Marking wire placement for improved accuracy in thoracic spinal surgery.
abstract: OBJECTIVE
  To 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.
  
  
  METHODS
  96 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.
  
  
  RESULTS
  Wire 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.
  
  
  CONCLUSIONS
  This 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.
authors.affiliation: Department of Neurosurgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany. Electronic address: ahmadi@med.uni-duesseldorf.de.
authors.forename: Sebastian A
authors.initials: SA
authors.lastname: Ahmadi
authors.affiliation: Department of Neurosurgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany.
authors.forename: Philipp J
authors.initials: PJ
authors.lastname: Slotty
authors.affiliation: Department of Neurosurgery, Uniklinik Köln, Cologne, Germany.
authors.forename: Catharina
authors.initials: C
authors.lastname: Schröter
authors.affiliation: Institute of Diagnostic and Interventional Radiology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany.
authors.forename: Patric
authors.initials: P
authors.lastname: Kröpil
authors.affiliation: Department of Neurosurgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany.
authors.forename: Hans-Jakob
authors.initials: HJ
authors.lastname: Steiger
authors.affiliation: Department of Neurosurgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany; Department of Neurosurgery, University of Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Sven O
authors.initials: SO
authors.lastname: Eicker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D011446:Prospective Studies; D011832:Radiation Injuries / Q000517:prevention & control; D013118:Spinal Cord Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D025321:Surgery, Computer-Assisted; D013525:Surgical Instruments; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Localization; Marking wire; Radiation exposure; Spine; Thoracic; Wrong-level surgery