Devoted to diagnostic and interventional spine imaging and therapeutics


Fluoroscopic-Guided Percutaneous Spinal Fiducial Markers for Intra-operative Localization 2012

Interventional Spine

Michael, J, Derr, D.O.
Jeffrey, A, Stone, M.D., Non ASSR Member



Intra-operative localization of the spinal level during surgery can be difficult with estimated wrong-level spinal surgery in 1 in 3,110 procedures and 50% of surgeons reporting one or more wrong level surgeries in their career. We present a case series demonstrating a new pre-operative localization technique that is safe, easy to perform and inexpensive.

Methods & Materials

Three consecutive patients undergoing thoracic spine surgery were referred for preoperative localization of the planned surgical level. The procedure was performed using frontal and lateral fluoroscopy several days prior to surgery. The localization was performed by implantation of a depleted Oncoseed (Oncura by GE Health Inc, Buckinghamshire, England) within the costo-vertebral notch at the side and site of planned surgical procedure using a standard 18-guage Chiba needle. Markers were placed at the level immediately above and below the intended surgical level. Rotational fluoroscopic computed tomography (CT) exam was performed to confirm proper marker position after deployment. Follow up fluoroscopy was performed the day of surgery to confirm stability.


The procedure was a technical success in all three patients as confirmed by Fluoroscopic-CT images. The markers were easily visualized at time of surgery using portable c-arm fluoroscopy. Each marker cost less than $20 US currency. Stability of fiducial marker location was confirmed in the three patients. Post surgical imaging confirmed correct level surgery.


Pre-operative fluoroscopic guided fiducial marker implantation within the costo-vertebral junction using depleted Oncoseed appears to be a reliable and cost-effective procedure that potentially reduces the risk of wrong level spinal surgery.

References/Financial Disclosures

Mody MG, Nourbakhsh A, Stahl DL, Gibbs M, Alfawareh M, Garges KJ. The prevalence of wrong level surgery among spine surgeons. Spine 2008; 33: 194-198.