Spinous process marking: a reliable method for preoperative surface localization of intradural lesions of the high...

Surgical exposure of intradural lesions in the thoracic spine requires intraoperative landmarks to identify the vertebral level. If spinal neuronavigation is not available, the surgeon must rely on alternative localizing methods. Intraoperative fluoroscopy is traditionally used to count the vertebrae throughout the whole spine. In the high thoracic spine, counting the vertebrae is often hampered by the scapular shadows. In these cases, a preoperative marking procedure seems preferable. Magnetic resonance imaging (MRI) based techniques have been increasingly reported, but they share an intrinsic risk of error due to the skin shift occurring at the time of surgery. We describe here a simple technique for unequivocal identification of the vertebral target. In six patients undergoing surgery for intradural lesions of the high thoracic spine, the spinous process of the vertebra corresponding to the lesion was preoperatively identified on an anteroposterior radiograph view and marked infiltrating its tip with a blue dye. At surgery, the vertebral target was identified easily and immediately. No errors occurred. No complications related to the technique were observed. Preoperative marking of the vertebral spinous process with a coloured dye is a simple and unequivocal guide to expose intradural lesions in the high thoracic spine.