Coil embolisation of intercostal artery for operative localisation of spinal dural arterio-venous fistulae

The utility of internal spinal marking for intraoperative localisation: A systematic review

BACKGROUND

Incorrect level spinal surgery is an avoidable complication, with significant ramifications. Several pre-operative spinal marking techniques have been described to aid intraoperative localisation.

METHODS

A systematic search of Ovid MEDLINE, and EMBASE was performed from inception to July 2022. All publications describing cases of internal spinal marking were included for further analysis. 22 articles describing 503 patients satisfied our eligibility criteria.

RESULTS

A number of localisation techniques, including endovascular coiling (n = 16), fiducials (n = 177), dye (n = 109), needle/fixed wire (n = 199), cement (n = 4), and gadolinium tubes (n = 1) were described. The highest rates of technical success were observed with endovascular coiling, fiducials, cement and dye (100 %), and complication rates were lowest with endovascular coiling, fiducials and cement (0 %).

CONCLUSIONS

Overall, internal spinal marking was effective and safe. When considering practicality and efficacy, fiducial marking appears the optimal technique, as it can be performed in the outpatient setting under local anaesthesia. This review demonstrates the need for more targeted investigation into localisation methods in spinal surgery.

Intra-operative MRI-assisted spinal localization

BACKGROUND

Level localization in the thoracic spine can be problematic. We describe a new method that can be used in difficult cases, e.g., ones where lesions are mid-thoracic, small, or only visible on MRI.

METHODS

Intra-operatively, a midline incision was made and the thoracic spinous processes were exposed. A length of contrast-filled tubing was wound around the processes and the incision was temporarily closed and the patient was transferred to the radiology department for MRI under general anesthetic. Upon return to theatre, the cross sections of contrast-filled tubing and the lesion itself were visible on the MRI scan, allowing localization of the level.

FINDINGS

This method was accurate and minimized the extent of bone removal required for access.

CONCLUSIONS

This technique, while not appropriate in every case, is repeatable, and does not require specialized equipment or training. It is an extremely accurate method of localization for difficult cases.