Skip to main content

Advertisement

SpringerLink
Log in

Intra-operative MRI-assisted spinal localization

  • Technical Note
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Summary

Background

Level localization in the thoracic spine can be problematic. We describe a new method that can be used in difficult cases, e.g., ones where lesions are mid-thoracic, small, or only visible on MRI.

Methods

Intra-operatively, a midline incision was made and the thoracic spinous processes were exposed. A length of contrast-filled tubing was wound around the processes and the incision was temporarily closed and the patient was transferred to the radiology department for MRI under general anesthetic. Upon return to theatre, the cross sections of contrast-filled tubing and the lesion itself were visible on the MRI scan, allowing localization of the level.

Findings

This method was accurate and minimized the extent of bone removal required for access.

Conclusions

This technique, while not appropriate in every case, is repeatable, and does not require specialized equipment or training. It is an extremely accurate method of localization for difficult cases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Barrett C, Jayakrishnan V, Gholkar A, Todd NV (2009) Coil embolisation of intercostal artery for operative localisation of spinal dural arterio-venous fistulae. Br J Neurosurg 23(3):332–334

    Article  CAS  PubMed  Google Scholar 

  2. Cornips E, Beuls E, Geskes G, Janssens M, van Aalst J, Hofman P (2007) Preoperative localization of herniated thoracic discs using myelo-CT guided transpleural puncture: technical note. Childs Nerv Syst 23(1):21–26, Epub 2006 Aug 30

    Article  PubMed  Google Scholar 

  3. Endres S, Riegel T, Wilke A (2005) Preoperative marking of thoracic disc herniation (in German). Orthopade 34(8):791–793

    Article  CAS  PubMed  Google Scholar 

  4. Foley KT, Simon DA, Rampersaud YR (2001) Virtual fluoroscopy: computer-assisted fluoroscopic navigation. Spine 26(4):347–351

    Article  CAS  PubMed  Google Scholar 

  5. Foley KT, Smith MM (1996) Image-guided spine surgery. Neurosurg Clin N Am 7(2):171–186

    CAS  PubMed  Google Scholar 

  6. Haberland N, Ebmeier K, Grunewald JP, Hliscs R, Kalff RL (2000) Incorporation of intraoperative computerized tomography in a newly developed spinal navigation technique. Comput Aided Surg 5(1):18–27

    Article  CAS  PubMed  Google Scholar 

  7. Holmaas G, Frederiksen D, Ulvik A, Vingsnes SO, Østgaard G, Nordli H (2006) Identification of thoracic intervertebral spaces by means of surface anatomy: a magnetic resonance imaging study. Acta Anaesthesiol Scand 50(3):368–373

    Article  CAS  PubMed  Google Scholar 

  8. Hsu W, Sciubba DM, Sasson AD, Khavkin Y, Wolinsky JP, Gailloud P, Gokaslan ZL, Murphy K (2008) Intraoperative localization of thoracic spine level with preoperative percutaneous placement of intravertebral polymethylmethacrylate. J Spinal Disord Tech 21(1):72–75

    Article  PubMed  Google Scholar 

  9. Kalfas IH, Kormos DW, Murphy MA, McKenzie RL, Barnett GH, Bell GR, Steiner CP, Trimble MB, Weisenberger JP (1995) Application of frameless stereotaxy to pedicle screw fixation of the spine. J Neurosurg 83(4):641–647

    Article  CAS  PubMed  Google Scholar 

  10. Nowitzke A, Wood M, Cooney K (2008) Improving accuracy and reducing errors in spinal surgery—a new technique for thoracolumbar-level localization using computer-assisted image guidance. Spine J 8(4):597–604, Epub 2007 Dec 21

    Article  PubMed  Google Scholar 

  11. 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(1):74–76

    Article  CAS  PubMed  Google Scholar 

  12. 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(5):346–348

    Article  PubMed  Google Scholar 

  13. Tsai KJ, Chen SH, Chen PQ (2004) Multiple parallel skin markers for minimal incision lumbar disc surgery; a technical note. MC Musculoskelet Disord 5:8

    Article  Google Scholar 

  14. Youkilis AS, Quint DJ, McGillicuddy JE, Papadopoulos SM (2001) Stereotactic navigation for placement of pedicle screws in the thoracic spine. Neurosurgery 48(4):771–778, discussion 778–9

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Regional Neurosciences Centre, Newcastle General Hospital, Newcastle Upon Tyne, UK

    Chris Barrett & Nicholas V. Todd

  2. Department of Neuroradiology, Regional Neurosciences Centre, Newcastle General Hospital, Newcastle Upon Tyne, UK

    Philip English & Dipayan Mitra

  3. Department of Anaesthesia, Regional Neurosciences Centre, Newcastle General Hospital, Newcastle Upon Tyne, UK

    Jerry Evans

Authors
  1. Chris Barrett
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Philip English
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jerry Evans
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dipayan Mitra
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nicholas V. Todd
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chris Barrett.

Additional information

Comments

Localization in the thoracic spine can be challenging, particularly in the setting of minimally invasive surgery. However, this localization technique seems like "a long run for a short slide". I have found counting ribs on an x-ray with a radiopaque marker in place to be very accurate, particularly when counting from below and assuming pre-operative confirmation of the actual number of ribs present. A pre-operative skin incision and muscle dissection over four or five segments that is subsequently closed for transport to the imaging device is hardly trivial. I would consider less risk to extend a bony exposure a level or two in order to find a mis-localized lesion in the unusual circumstance where radiographic localization fails.

H. Louis Harkey

Mississippi, USA

As a technical note, the authors report, an ingenious procedure to localize lesions in the thoracic spine, a region of difficult surgical navigation. The described technique takes advantage of per-operatively implanted gadolinium-enhanced interspinous process markers that are, thus, later co-registered with the surgical lesion. Being a two-staged procedure that implies the displacement of patients from the OR to the MRI suite and return, may not feasible in many hospitals worldwide. As the intra-operative transfer of patients to MRI may not be devoid of risks, and neuronavigational systems are time consuming, I still stand with more basic techniques.

Oscar Alves

Porto, Portugal

Rights and permissions

Reprints and permissions

About this article

Cite this article

Barrett, C., English, P., Evans, J. et al. Intra-operative MRI-assisted spinal localization. Acta Neurochir 152, 669–673 (2010). https://doi.org/10.1007/s00701-009-0543-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-009-0543-7

Keywords

Search

Navigation