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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: 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.Based on the film taken, the incision can be accurately made at the intended level.

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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A 3 cm incision is needed for one-level discectomy.
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Figure 4: A 3 cm incision is needed for one-level discectomy.

Mentions: Usually, a 3 cm incision is needed for one-level disectomy (Fig. 4). The fascia is incised at the midline using electrocautery, and a periosteal elevator is inserted in the midline incision. Using gentle lateral movements, the deep fascia and muscle is subperiosteally separated from the spinous processes and lamina. Meticulous electrocautery is needed to minimize bleeding. A finger is then inserted to allow palpation of the interlaminar space. If necessary, bayonet forceps are placed in the interlaminar space and a permanent lateral view is again taken to confirm the level before performing the discectomy.


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

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

A 3 cm incision is needed for one-level discectomy.
© Copyright Policy
Related In: Results  -  Collection

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

Figure 4: A 3 cm incision is needed for one-level discectomy.
Mentions: Usually, a 3 cm incision is needed for one-level disectomy (Fig. 4). The fascia is incised at the midline using electrocautery, and a periosteal elevator is inserted in the midline incision. Using gentle lateral movements, the deep fascia and muscle is subperiosteally separated from the spinous processes and lamina. Meticulous electrocautery is needed to minimize bleeding. A finger is then inserted to allow palpation of the interlaminar space. If necessary, bayonet forceps are placed in the interlaminar space and a permanent lateral view is again taken to confirm the level before performing the discectomy.

Bottom Line: 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.Based on the film taken, the incision can be accurately made at the intended level.

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