Intraoperative localization of thoracic spine level with preoperative percutaneous placement of intravertebral polymethylmethacrylate

Wesley Hsu, Daniel Sciubba, A. Daniel Sasson, Yevgeniy Khavkin, Jean Paul Wolinsky, Philippe Gailloud, Ziya L. Gokaslan, Kieran Murphy

Research output: Contribution to journalArticle

Abstract

Objective: To evaluate the safety and utility of preoperative vertebroplasty for intraoperative localization of thoracic spinal levels. Summary of Background Data: Intraoperative fluoroscopy or plain radiographs are traditionally used to localize thoracic spine levels during thoracic spine operations. Unfortunately, such localization can occasionally be difficult in the midthoracic levels due to lack of landmarks, scapular shadows, and the body habitus of the morbidly obese. There are multiple techniques described in the literature that allow for preoperative localization of thoracic spinal levels during approaches to the posterior thoracic spine. For efficient and accurate intraoperative localization of thoracic spinal levels during anterior thoracic spine procedures, we describe a method that uses preoperative percutaneous placement of polymethylmethacrylate (PMMA) into the vertebral body using standard vertebroplasty technique. Methods: Four patients with morbid obesity and symptomatic thoracic disc herniations underwent preoperative vertebroplasty procedures using standard percutaneous techniques. The PMMA cement was used to expeditiously identify thoracic spinal levels of interest using intraoperative fluoroscopy. Results: All 4 patients underwent successful vertebroplasty procedures without complications. The PMMA cement was easily identified intraoperatively and led to the correct identification of the thoracic spinal levels of interest. Conclusions: Preoperative placement of PMMA into thoracic vertebral bodies using standard vertebroplasty technique provides a safe, efficient, and reliable method of localizing thoracic spine levels intraoperatively. Such procedures can be performed in the outpatient setting and can be associated with extremely low morbidity when done by experienced practitioners. This procedure should be reserved for patients in whom a surgeon anticipates difficulty using standard radiographs or fluoroscopy to localize thoracic spinal levels intraoperatively.

Original languageEnglish (US)
Pages (from-to)72-75
Number of pages4
JournalJournal of Spinal Disorders and Techniques
Volume21
Issue number1
DOIs
StatePublished - Feb 2008

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Polymethyl Methacrylate
Spine
Thorax
Vertebroplasty
Fluoroscopy
Preoperative Care
Morbid Obesity
Outpatients

Keywords

  • Disc
  • Localization
  • Percutaneous
  • Thoracic spine
  • Vertebroplasty

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Intraoperative localization of thoracic spine level with preoperative percutaneous placement of intravertebral polymethylmethacrylate. / Hsu, Wesley; Sciubba, Daniel; Sasson, A. Daniel; Khavkin, Yevgeniy; Wolinsky, Jean Paul; Gailloud, Philippe; Gokaslan, Ziya L.; Murphy, Kieran.

In: Journal of Spinal Disorders and Techniques, Vol. 21, No. 1, 02.2008, p. 72-75.

Research output: Contribution to journalArticle

Hsu, Wesley ; Sciubba, Daniel ; Sasson, A. Daniel ; Khavkin, Yevgeniy ; Wolinsky, Jean Paul ; Gailloud, Philippe ; Gokaslan, Ziya L. ; Murphy, Kieran. / Intraoperative localization of thoracic spine level with preoperative percutaneous placement of intravertebral polymethylmethacrylate. In: Journal of Spinal Disorders and Techniques. 2008 ; Vol. 21, No. 1. pp. 72-75.
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abstract = "Objective: To evaluate the safety and utility of preoperative vertebroplasty for intraoperative localization of thoracic spinal levels. Summary of Background Data: Intraoperative fluoroscopy or plain radiographs are traditionally used to localize thoracic spine levels during thoracic spine operations. Unfortunately, such localization can occasionally be difficult in the midthoracic levels due to lack of landmarks, scapular shadows, and the body habitus of the morbidly obese. There are multiple techniques described in the literature that allow for preoperative localization of thoracic spinal levels during approaches to the posterior thoracic spine. For efficient and accurate intraoperative localization of thoracic spinal levels during anterior thoracic spine procedures, we describe a method that uses preoperative percutaneous placement of polymethylmethacrylate (PMMA) into the vertebral body using standard vertebroplasty technique. Methods: Four patients with morbid obesity and symptomatic thoracic disc herniations underwent preoperative vertebroplasty procedures using standard percutaneous techniques. The PMMA cement was used to expeditiously identify thoracic spinal levels of interest using intraoperative fluoroscopy. Results: All 4 patients underwent successful vertebroplasty procedures without complications. The PMMA cement was easily identified intraoperatively and led to the correct identification of the thoracic spinal levels of interest. Conclusions: Preoperative placement of PMMA into thoracic vertebral bodies using standard vertebroplasty technique provides a safe, efficient, and reliable method of localizing thoracic spine levels intraoperatively. Such procedures can be performed in the outpatient setting and can be associated with extremely low morbidity when done by experienced practitioners. This procedure should be reserved for patients in whom a surgeon anticipates difficulty using standard radiographs or fluoroscopy to localize thoracic spinal levels intraoperatively.",
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AB - Objective: To evaluate the safety and utility of preoperative vertebroplasty for intraoperative localization of thoracic spinal levels. Summary of Background Data: Intraoperative fluoroscopy or plain radiographs are traditionally used to localize thoracic spine levels during thoracic spine operations. Unfortunately, such localization can occasionally be difficult in the midthoracic levels due to lack of landmarks, scapular shadows, and the body habitus of the morbidly obese. There are multiple techniques described in the literature that allow for preoperative localization of thoracic spinal levels during approaches to the posterior thoracic spine. For efficient and accurate intraoperative localization of thoracic spinal levels during anterior thoracic spine procedures, we describe a method that uses preoperative percutaneous placement of polymethylmethacrylate (PMMA) into the vertebral body using standard vertebroplasty technique. Methods: Four patients with morbid obesity and symptomatic thoracic disc herniations underwent preoperative vertebroplasty procedures using standard percutaneous techniques. The PMMA cement was used to expeditiously identify thoracic spinal levels of interest using intraoperative fluoroscopy. Results: All 4 patients underwent successful vertebroplasty procedures without complications. The PMMA cement was easily identified intraoperatively and led to the correct identification of the thoracic spinal levels of interest. Conclusions: Preoperative placement of PMMA into thoracic vertebral bodies using standard vertebroplasty technique provides a safe, efficient, and reliable method of localizing thoracic spine levels intraoperatively. Such procedures can be performed in the outpatient setting and can be associated with extremely low morbidity when done by experienced practitioners. This procedure should be reserved for patients in whom a surgeon anticipates difficulty using standard radiographs or fluoroscopy to localize thoracic spinal levels intraoperatively.

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