{"id":"5c86726b-d076-4a2f-a069-6ef2ee158fe0","slug":"bone-cylinder-plug-and-coil-technique-for-accurate-pedicle-localization-in-thoracic-spine-surgery-a-technical-note","title":"Bone cylinder plug and coil technique for accurate pedicle localization in thoracic spine surgery: A technical note","authors":["Rodolfo Maduri","Daniele Starnoni","Juan Barges-Coll","Steven David Hajdu","John Michael Duff"],"abstract":"Background: Intraoperative identification of the correct level during thoracic spine surgery is essential to avoid wrong-level procedures. Despite technological progress, intraoperative imaging modalities for identifying the correct thoracic spine level remain unreliable and often lead to wrong-level surgery. To counter potential wrong-level operations, here, we have proposed a novel pedicle/bone cylinder marking technique for use in the thoracic spine utilizing biplanar fluoroscopy and confirmed with computed tomography (CT). Methods: First, under fluoroscopic guidance, a bone cylinder is removed from the correct thoracic pedicle. Next, endovascular coils are packed into the cancellous bone defect followed by reinsertion of the bony plug. The patient then undergoes a CT scan of the entire thoracolumbosacral spine to precisely identify the marked level before surgery. Results: We utilized this bone cylinder plug/coil technique to identify the T9-T10 level in a 56-year-old female with a soft thoracic disc herniation. The index thoracic pedicle was successfully localized before performing the unilateral minimally invasive laminectomy followed by the transpedicular thoracic disc excision. Conclusion: The bone cylinder plug/coil technique is a safe and effective method for marking the correct level in thoracic spine surgery, while also reducing the operative time.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/5c86726b-d076-4a2f-a069-6ef2ee158fe0/featured/hero-1781563892142.png","publishDate":"2019-06-19T00:00:00.000Z","doi":"10.25259/SNI-258-2019","categories":["Spine","Technical Note"],"fullTextUrl":"http://surgicalneurologyint.com/wp-content/uploads/2019/06/9380/SNI-10-104.pdf"}