The utility of preoperative computed tomography-guided screw marking in thoracic spine surgery
Introduction: Wrong-level surgery (WLS) is a preventable yet severe complication in spinal surgery, particularly for pathologies located in the thoracic spine, where localizing the intended level is more challenging compared to the lumbar or cervical spine, which have more distinct landmark structur...
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Elsevier
2025-01-01
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| Series: | Brain and Spine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772529425001523 |
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| author | Christopher Marvin Jesse Aatharshan Kannathasan Ralph T. Schär Johannes Goldberg Andreas Raabe Jan Gralla Johannes Kaesmacher Tomas Dobrocky Eike Immo Piechowiak |
| author_facet | Christopher Marvin Jesse Aatharshan Kannathasan Ralph T. Schär Johannes Goldberg Andreas Raabe Jan Gralla Johannes Kaesmacher Tomas Dobrocky Eike Immo Piechowiak |
| author_sort | Christopher Marvin Jesse |
| collection | DOAJ |
| description | Introduction: Wrong-level surgery (WLS) is a preventable yet severe complication in spinal surgery, particularly for pathologies located in the thoracic spine, where localizing the intended level is more challenging compared to the lumbar or cervical spine, which have more distinct landmark structures and fewer vertebral bodies. Research question: Evaluate the impact of preoperative, computed tomography (CT)-guided screw marking on avoiding WLS and optimizing intraoperative workflows. Material and methods: We conducted a retrospective case-control study at Bern University Hospital, enrolling all patients treated with thoracic spinal surgery between February 2017 and August 2022. Patients that received preoperative, CT-guided screw marking in the pedicle at the index level were compared to those without preoperative marking. Data included clinical features, radiological parameters, and complications. Primary endpoint: occurrence of WLS. Secondary endpoints: duration of intraoperative fluoroscopy, operating room (OR) occupancy time, and complications. Results: A total of 117 patients were included: 71 in the screw group and 46 in the control group. The mean age was 54 (±16) years. Significant differences were found in the indication for surgery (p = 0.002). No significant differences were observed in duration of intraoperative fluoroscopy, effective dose, or total OR occupancy time. WLS occurred in only one patient in the control group and none in the screw group. Surgical complications were similar between groups. Discussion and conclusion: We present a safe technique with a low complication rate for preoperative marking of the index vertebra before thoracic spinal surgery, allowing spine surgeons to eliminate the risk of WLS. |
| format | Article |
| id | doaj-art-65dcc52dafd643cea3b5fcbb5fedc4dd |
| institution | DOAJ |
| issn | 2772-5294 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brain and Spine |
| spelling | doaj-art-65dcc52dafd643cea3b5fcbb5fedc4dd2025-08-20T02:48:34ZengElsevierBrain and Spine2772-52942025-01-01510433310.1016/j.bas.2025.104333The utility of preoperative computed tomography-guided screw marking in thoracic spine surgeryChristopher Marvin Jesse0Aatharshan Kannathasan1Ralph T. Schär2Johannes Goldberg3Andreas Raabe4Jan Gralla5Johannes Kaesmacher6Tomas Dobrocky7Eike Immo Piechowiak8Department of Neurosurgery, Inselspital, Bern University Hospital, and University of Bern, Bern, SwitzerlandDepartment of Neurosurgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland; Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, SwitzerlandDepartment of Neurosurgery, Inselspital, Bern University Hospital, and University of Bern, Bern, SwitzerlandDepartment of Neurosurgery, Inselspital, Bern University Hospital, and University of Bern, Bern, SwitzerlandDepartment of Neurosurgery, Inselspital, Bern University Hospital, and University of Bern, Bern, SwitzerlandInstitute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, SwitzerlandInstitute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, SwitzerlandInstitute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, SwitzerlandInstitute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland; Corresponding author. Universitätsinstitut für Diagnostische und Interventionelle Neuroradiologie Inselspital Bern Rosenbühlgasse 25, 3010, Bern, Switzerland.Introduction: Wrong-level surgery (WLS) is a preventable yet severe complication in spinal surgery, particularly for pathologies located in the thoracic spine, where localizing the intended level is more challenging compared to the lumbar or cervical spine, which have more distinct landmark structures and fewer vertebral bodies. Research question: Evaluate the impact of preoperative, computed tomography (CT)-guided screw marking on avoiding WLS and optimizing intraoperative workflows. Material and methods: We conducted a retrospective case-control study at Bern University Hospital, enrolling all patients treated with thoracic spinal surgery between February 2017 and August 2022. Patients that received preoperative, CT-guided screw marking in the pedicle at the index level were compared to those without preoperative marking. Data included clinical features, radiological parameters, and complications. Primary endpoint: occurrence of WLS. Secondary endpoints: duration of intraoperative fluoroscopy, operating room (OR) occupancy time, and complications. Results: A total of 117 patients were included: 71 in the screw group and 46 in the control group. The mean age was 54 (±16) years. Significant differences were found in the indication for surgery (p = 0.002). No significant differences were observed in duration of intraoperative fluoroscopy, effective dose, or total OR occupancy time. WLS occurred in only one patient in the control group and none in the screw group. Surgical complications were similar between groups. Discussion and conclusion: We present a safe technique with a low complication rate for preoperative marking of the index vertebra before thoracic spinal surgery, allowing spine surgeons to eliminate the risk of WLS.http://www.sciencedirect.com/science/article/pii/S2772529425001523Spontaneous intracranial hypotensionSpine surgeryIntraoperative fluoroscopyWrong-level surgery |
| spellingShingle | Christopher Marvin Jesse Aatharshan Kannathasan Ralph T. Schär Johannes Goldberg Andreas Raabe Jan Gralla Johannes Kaesmacher Tomas Dobrocky Eike Immo Piechowiak The utility of preoperative computed tomography-guided screw marking in thoracic spine surgery Brain and Spine Spontaneous intracranial hypotension Spine surgery Intraoperative fluoroscopy Wrong-level surgery |
| title | The utility of preoperative computed tomography-guided screw marking in thoracic spine surgery |
| title_full | The utility of preoperative computed tomography-guided screw marking in thoracic spine surgery |
| title_fullStr | The utility of preoperative computed tomography-guided screw marking in thoracic spine surgery |
| title_full_unstemmed | The utility of preoperative computed tomography-guided screw marking in thoracic spine surgery |
| title_short | The utility of preoperative computed tomography-guided screw marking in thoracic spine surgery |
| title_sort | utility of preoperative computed tomography guided screw marking in thoracic spine surgery |
| topic | Spontaneous intracranial hypotension Spine surgery Intraoperative fluoroscopy Wrong-level surgery |
| url | http://www.sciencedirect.com/science/article/pii/S2772529425001523 |
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