Chin Kingsley R, Seale Jason, Cumming Vanessa
*Department of Clinical Biomedical Sciences, Charles E. Schmidt College of Medicine at Florida Atlantic University †Institute for Modern and Innovative Surgery (iMIS) ‡LES Society, Fort Lauderdale, FL.
Clin Spine Surg. 2017 Feb;30(1):E54-E58. doi: 10.1097/BSD.0b013e3182a35762.
A technical report.
The aim of the present study was to present an improvement on localization techniques employed for use in the thoracic spine using sterile spinal needles docked on the transverse process of each vertebra, which can be performed in both percutaneous and open spinal procedures.
Wrong-level surgery may have momentous clinical and emotional implications for a patient and surgeon. It is reported that one in every 2 spine surgeons will operate on the wrong level during his or her career. Correctly localizing the specific thoracic level remains a significant challenge during spine surgery.
Fluoroscopic anteroposterior and lateral views were obtained starting in the lower lumbar spine, and an 18-G spinal needle was placed in the transverse process of L3 counting up from the sacrum and also at T12. The fluoroscopy was then moved cephalad and counting from the spinal needle at T12, the other spinal needles were placed at the targeted operating thoracic vertebrae. Once this was done, we were able to accurately determine the thoracic levels for surgical intervention.
Using this technique, the markers were kept in place even after the incisions were made. This prevented us from losing our location in the thoracic spine. Correctly placed instrumentation was made evident with postoperative imaging.
We have described the successful use of a new technique using spinal needles docked against transverse processes to correctly and reliably identify thoracic levels before instrumentation. The technique was reproducible in both open surgeries and for a percutaneous procedure. This technique maintains the correct spinal level during an open procedure. We posit that wrong-level thoracic spine surgery may be preventable.
技术报告。
本研究的目的是对用于胸椎的定位技术进行改进，该技术使用无菌脊柱针固定在每个椎骨的横突上，可在经皮和开放性脊柱手术中进行。
错误节段手术可能对患者和外科医生产生重大的临床和情感影响。据报道，每2名脊柱外科医生中就有1人在其职业生涯中会进行错误节段的手术。在脊柱手术中，准确确定特定的胸椎节段仍然是一项重大挑战。
从下腰椎开始获取荧光透视前后位和侧位视图，将一根18G脊柱针置于从骶骨向上计数的L3横突以及T12横突处。然后将荧光透视设备向头侧移动，从T12处的脊柱针开始计数，将其他脊柱针置于目标手术胸椎处。完成此操作后，我们能够准确确定手术干预的胸椎节段。
使用该技术，即使在切开后标记物仍保持在原位。这使我们在胸椎中不会迷失位置。术后影像学检查显示器械放置正确。
我们描述了一种新技术的成功应用，该技术使用靠在横突上的脊柱针在器械置入前正确且可靠地识别胸椎节段。该技术在开放性手术和经皮手术中均可重复使用。该技术在开放性手术中能保持正确的脊柱节段。我们认为错误节段的胸椎手术可能是可预防的。
