Accuracy and evaluation of irradiation of novel localization devices with unique three-dimensional structures in microendoscopic spine surgery

  • Masanari TakamiEmail author
  • Amr Elwany
  • Jean Destandau
Original Article • SPINE - ENDOSCOPY



Although many reports are available on using a variety of instruments and techniques to prevent wrong-level spine surgery, the accurate localization of the correct spinal level remains problematic. At the same time, surgeons are also required to reduce radiation exposure to patients and operating room personnel. To solve these problems, we developed and used specially designed marking devices with a unique three-dimensional structure.


To evaluate the accuracy of our novel devices for localization of the spinal level to prevent wrong-level surgery and reduce the amount and time of radiation exposure during surgery.

Study design

This was a retrospective cohort study.


In 8240 consecutive patients who underwent microendoscopic spine surgery between 1993 and 2012, the incidence of wrong-level surgery was studied. In addition, the amount of radiation exposure and total fluoroscopy time were measured in recent 100 consecutive patients using a digital dosimeter attached to the fluoroscope.


Eight (0.097 %) patients had undergone wrong-level surgery. The average radiation exposure was 0.26 mGy (range 0.10–1.15 mGy), and the average total fluoroscopy time was 3.1 s (range 1–7 s).


Our novel localization devices and technique for their use in spine surgery are reliable and accurate for identifying the target level and contributed to reductions in preoperative localization error and radiation exposure to patients and operating room personnel.


Localization device Spine surgery Microendoscopic surgery Wrong-level surgery Radiation exposure 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Ammerman JM, Ammerman MD, Dambrosia J, Ammerman BJ (2006) A prospective evaluation of the role for intraoperative X-ray in lumbar discectomy. Predictors of incorrect level exposure. Surg Neurol 66:470–474CrossRefPubMedGoogle Scholar
  2. 2.
    Jhawar BS, Mitsis D, Duggal N (2007) Wrong-sided and wrong-level neurosurgery: a national survey. J Neurosurg Spine 7:467–472CrossRefPubMedGoogle Scholar
  3. 3.
    Devine J, Chutkan N, Norvell DC, Dettori JR (2010) Avoiding wrong site surgery: a systematic review. Spine 35:S28–S36CrossRefPubMedGoogle Scholar
  4. 4.
    Hsiang J (2011) Wrong-level surgery: a unique problem in spine surgery. Surg Neurol Int 2:47PubMedPubMedCentralGoogle Scholar
  5. 5.
    Mody MG, Nourbakhsh A, Stahn DL, Gibbs M, Alfawareh M, Garges KJ (2008) The prevalence of wrong level surgery among spine surgeons. Spine 33:194–198CrossRefPubMedGoogle Scholar
  6. 6.
    Binning MJ, Schmidt MH (2010) Percutaneous placement of radiopaque markers at the pedicle of interest for preoperative localization of thoracic spine level. Spine (Phila Pa 1976) 35:1821–1825CrossRefGoogle Scholar
  7. 7.
    Hsu W, Sciubba DM, Sasson AD et al (2008) Intraoperative localization of thoracic spine level with preoperative percutaneous placement of intravertebral polymethylmethacrylate. J Spinal Disord Tech 21:72–75CrossRefPubMedGoogle Scholar
  8. 8.
    Lindley EM, Botolin S, Burger EL, Patel VV (2011) Unusual spine anatomy contributing to wrong level spine surgery: a case report and recommendations for decreasing the risk of preventable ‘never events’. Patient Saf Surg 5:33CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Watkins RG (2001) Surgical approaches to the spine. In: Chapman MW (ed) Chapman’s orthopedic surgery, 3rd edn. LWW, Philadelphia, pp 3654–3655Google Scholar
  10. 10.
    Miccoli P, Berti P, Raffaelli M, Materazzi G, Conte M, Faldini A (2001) Minimally invasive approach to the cervical spine: a proposal. J Laparoendos Adv Surg Tech 11:89–92CrossRefGoogle Scholar
  11. 11.
    Wilson D, Harbaugh R (1981) Microsurgical and standard removal of the protruded lumbar disc: a comparative study. Neurosurgery 8:422–427CrossRefPubMedGoogle Scholar
  12. 12.
    Mohanial P, Pal D, Timothy J (2006) Localization of spinal level in lumbar microdiscectomy. Eur J Orthop Traumatol 16:207–209CrossRefGoogle Scholar
  13. 13.
    Paolini S, Ciappetta P, Missori P, Raco A, Delfini R (2005) Spinous process marking: a reliable method for preoperative surface localization of intradural lesions of the high thoracic spine. Br J Neurosurg 19:74–76CrossRefPubMedGoogle Scholar
  14. 14.
    Redfern RM, Smith ET (1986) A method for identification of vertebral level. Ann R Coll Surg Engl 68:163PubMedPubMedCentralGoogle Scholar
  15. 15.
    Rosahl SK, Gharabaghi A, Liebig T, Feste CD, Tatagiba M, Samii M (2002) Skin markers for surgical planning for intradural lesions of the thoracic spine. Technical note. Surg Neurol 58:346–348CrossRefPubMedGoogle Scholar
  16. 16.
    Singh H, Meyer SA, Hecht AC, Jenkins AL (2009) Novel fluoroscopic technique for localization at cervicothoracic levels. J Spinal Disord Tech 22:615–618CrossRefPubMedGoogle Scholar
  17. 17.
    Tsai KJ, Chen SH, Chen PQ (2004) Multiple parallel skin markers for minimal incision lumbar disc surgery; a technical note. BMC Musculoskelet Disord 5:8CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Upadhyaya CD, Wu JC, Chin CT, Balamurali G, Mummaneni PV (2012) Avoidance of wrong-level thoracic spine surgery: intraoperative localization with preoperative percutaneous fiducial screw placement. J Neurosurg Spine 16:280–284CrossRefPubMedGoogle Scholar
  19. 19.
    Lee K, Lee KM, Park MS, Lee B, Kwon DG, Chung CY (2012) Measurements of surgeons’ exposure to ionizing radiation dose during intraoperative use of C-arm fluoroscopy. Spine (Phila Pa 1976) 37:1240–1244CrossRefGoogle Scholar
  20. 20.
    Mariscalco MW, Yamashita T, Steinmetz MP, Krishnaney AA, Lieberman IH, Mroz TE (2011) Radiation exposure to the surgeon during open lumbar microdiscectomy and minimally invasive microdiscectomy: a prospective, controlled trial. Spine (Phila Pa 1976) 36:255–260CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France 2016

Authors and Affiliations

  1. 1.Department of Micro-Endoscopic Spine SurgeryBordeauxFrance

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