gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

An innovative approach to improve safety in targeting accurate levels in thoracic spinal surgery

Meeting Abstract

  • S.A. Ahmadi - Heinrich-Heine-Universität Düsseldorf, Neurochirurgische Klinik
  • P. Slotty - Heinrich-Heine-Universität Düsseldorf, Neurochirurgische Klinik
  • D. Hänggi - Heinrich-Heine-Universität Düsseldorf, Neurochirurgische Klinik
  • H.J. Steiger - Heinrich-Heine-Universität Düsseldorf, Neurochirurgische Klinik
  • S.O. Eicker - Heinrich-Heine-Universität Düsseldorf, Neurochirurgische Klinik

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocSA.09.08

doi: 10.3205/12dgnc369, urn:nbn:de:0183-12dgnc3691

Published: June 4, 2012

© 2012 Ahmadi et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Identifying the level of interest in thoracic spinal surgery can be a significant challenge to the surgeon. Operating at wrong levels not only results in additional surgery with all its inherent risks but also usually leads to costly litigation. To date, most institutions rely on intraoperative x-ray imaging to properly identify target levels. At thoracic levels especially identification of specific vertebral bodies can be suboptimal due to the unique anatomy and structure of the thoracic spine. Our objective was to present an innovative approach and critically appraise its value in reducing the risk of wrong-level surgery.

Methods: Preoperatively a flexible hooked wire needle derived from breast cancer surgery was inserted under computed tomography (CT-) guidance at the site of interest – the wire was then used as an intraoperative guidance tool. A historical case of wrong-level surgery is presented and discussed.

Results: We employed this technique in 10 consecutive patients. On postoperative CT imaging all cases showed accurate-level placement of instrumentation. No adverse reactions and no post-operative infections were observed in this series. Patients reported some minor discomfort on insertion but no wires had to be removed due to lack of patient compliance.

Conclusions: We hereby demonstrated a safe and practical approach to identify the level of interest in thoracic spinal surgery employing a flexible hooked wire. Its application is not limited to thoracic surgery but merits consideration in any spinal case where x-ray localization could be impeded.