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Multiple parallel skin markers for minimal incision lumbar disc surgery; a technical note.

Tsai KJ, Chen SH, Chen PQ - BMC Musculoskelet Disord (2004)

Bottom Line: The longest line was placed on the line of the postero-superior iliac spine (PSIS) over the junction of the L5-S1 region.Based on the film taken, the incision can be accurately made at the intended level.The incision wound can be minimized to 3.0 cm even when using conventional disc surgery instruments.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan. tsaikj@ms2.hinet.net

ABSTRACT

Background: Spinal surgery depends on accurate localization to prevent incorrect surgical approaches. The trend towards minimally invasive surgery that minimizes surgical exposure and reduces postoperative pain increasingly requires surgeons to accurately determine the operative level before an incision is made. Preoperative localization with a C-arm image intensifier is popular, but the exposure of both patients and theatre staff to radiation is a disadvantage, as well as being time-consuming.

Methods: We describe a simple surgical tool developed to help localize exact spinal levels in conjunction with a simple AP X-ray film immediately before surgery. Multiple parallel skin markers were made using a circular oven rack comprising multiple 1.5 cm spaced parallel wires attached to a circular outside rim. The longest line was placed on the line of the postero-superior iliac spine (PSIS) over the junction of the L5-S1 region.

Results and conclusions: Based on the film taken, the incision can be accurately made at the intended level. The incision wound can be minimized to 3.0 cm even when using conventional disc surgery instruments.

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Related in: MedlinePlus

A circular oven rack is placed over the surgical field.
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Figure 1: A circular oven rack is placed over the surgical field.

Mentions: Under general anesthesia, the patient is evenly placed in a prone position on the frame, suspending the abdomen to relieve abdominal pressure. The posterior superior iliac spines (PSIS) are palpated and lines drawn to connect both PSIS's with a permanent marker pencil. This line is supposed to pass between L5 and S1. A circular oven rack is then placed on the surgical field (Fig. 1). A preoperative permanent posterior-anterior (PA) film is then taken. Multiple parallel lines are then drawn on the skin along the 1.5 cm spaced parallel wires of the oven rack with the permanent marker pencil (Fig. 2). The surgical field is then disinfected and draped. The PA film of the lumbar spine allows the correct level of the lumbar spine to be determined simply by counting the lines until the desired disc space is reached (Fig. 3). A small incision is then made.


Multiple parallel skin markers for minimal incision lumbar disc surgery; a technical note.

Tsai KJ, Chen SH, Chen PQ - BMC Musculoskelet Disord (2004)

A circular oven rack is placed over the surgical field.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC394334&req=5

Figure 1: A circular oven rack is placed over the surgical field.
Mentions: Under general anesthesia, the patient is evenly placed in a prone position on the frame, suspending the abdomen to relieve abdominal pressure. The posterior superior iliac spines (PSIS) are palpated and lines drawn to connect both PSIS's with a permanent marker pencil. This line is supposed to pass between L5 and S1. A circular oven rack is then placed on the surgical field (Fig. 1). A preoperative permanent posterior-anterior (PA) film is then taken. Multiple parallel lines are then drawn on the skin along the 1.5 cm spaced parallel wires of the oven rack with the permanent marker pencil (Fig. 2). The surgical field is then disinfected and draped. The PA film of the lumbar spine allows the correct level of the lumbar spine to be determined simply by counting the lines until the desired disc space is reached (Fig. 3). A small incision is then made.

Bottom Line: The longest line was placed on the line of the postero-superior iliac spine (PSIS) over the junction of the L5-S1 region.Based on the film taken, the incision can be accurately made at the intended level.The incision wound can be minimized to 3.0 cm even when using conventional disc surgery instruments.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan. tsaikj@ms2.hinet.net

ABSTRACT

Background: Spinal surgery depends on accurate localization to prevent incorrect surgical approaches. The trend towards minimally invasive surgery that minimizes surgical exposure and reduces postoperative pain increasingly requires surgeons to accurately determine the operative level before an incision is made. Preoperative localization with a C-arm image intensifier is popular, but the exposure of both patients and theatre staff to radiation is a disadvantage, as well as being time-consuming.

Methods: We describe a simple surgical tool developed to help localize exact spinal levels in conjunction with a simple AP X-ray film immediately before surgery. Multiple parallel skin markers were made using a circular oven rack comprising multiple 1.5 cm spaced parallel wires attached to a circular outside rim. The longest line was placed on the line of the postero-superior iliac spine (PSIS) over the junction of the L5-S1 region.

Results and conclusions: Based on the film taken, the incision can be accurately made at the intended level. The incision wound can be minimized to 3.0 cm even when using conventional disc surgery instruments.

Show MeSH
Related in: MedlinePlus