A Novel Technique to Improve Intraoperative Visualization for the Lower Cervical Spine in Spine Surgery

Localising the lower cervical spine intraoperatively using conventional fluoroscopy with lateral projections has limitations. The main factor limiting the adequate visualisation of the cervicothoracic spaces is the superposition of the shoulder's structures (soft tissue, muscle, and bone), which creates a significant obstacle when making intraoperative decisions. Various techniques have been described for this purpose. Some are complex and involve different X-ray projection angles or the creation of special devices. However, fluoroscopy techniques using conventional AP and lateral projections can be employed in conjunction with shoulder traction, dorsiflexion of the feet, and pushing the feet upward to accurately identify lower cervical spaces and even the cervicothoracic junction. This technique is unique in that it is cost effective, yielding favourable results without requiring investment in new or expensive devices. Both shoulders were secured to the operating table using shoulder traction, and dorsiflexion and pushing the feet upward bilaterally were performed simultaneously. Doing so enabled the capture of favourable images and the implementation of accurate surgical approaches to treat lower cervical structures. The usefulness of this new technique for visualising lower cervical spaces was demonstrated in the presented cases. Our technique facilitates the acquisition of fluoroscopic images with adequate magnification and accurate visualisation of the lower cervical spaces. The results were similar to those of other studies.