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Research - Pain Management and Spinal Surgery

Use of a radiopaque localizer grid to reduce radiation exposure

Kee D Kim et al. Chief of spinal surgery and co-director University of California Davis Spine Center

Published in the Annals of Surgical Innovation and Research 2011 - no affiliation with Target Tape Inc. before publishing

Abbreviated version




Traditional methods of localizing spinal incisions using radiopaque markers such as k-wires require numerous radiographic images in a trial-and-error fashion.

Spine surgeons are especially at risk from increased radiation exposure [7].

Sub-optimal entry points may lead to increased operative time, complications or inability to perform the procedure [1-6].


Figure 1 Paramedian incisions for L4 to S1 instrumented fusion.



A radiopaque localizer grid was utilized to plan the point of entry for minimally invasive spine surgery with only one or two AP fluoroscopic images versus the six to twelve typically obtained. Its use also allowed a decrease in total operative time. 

The first case involved a patient who underwent L4 to S1 instrumented fusion (see figures 1, 2).

Another example involved radiofrequency facet denervation, where twelve lesioning needles are placed on the back. Without the grid, multiple fluoroscopic images would have been necessary.


Figure 2 AP X-ray shows L4 to S1 instrumented fusion (MIS)


Faster and with less radiation

Without X-Grid, multiple fluoro images are performed with needles or k-wires at different sites. The process is cumbersome and prone to trial and error. The images below show a surgeon creating a grid from scratch by imaging each level one by one for a lumbar fusion.

Various sizes possible

The grids can be custom sized for different procedure types in various regions of the body. The Small X-Grid has a grid that is 8 cm by 12 cm, with 2 cm increments.

A Large X-Grid is available that is 6” by 8”, with 1” increments for the back.





Small 8 cm by 12 cm grid

  1. Kim, et al: Use of a radiopaque localizer grid to reduce radiation exposure. Annals of Surg Innov and Research 2011, 5:6.
  2. Rampersaud RY, et al: Radiation exposure to the spine surgeon during fluoroscopically assisted pedicle screw insertion. Spine 2000; 25:2637-45.
  3. Tsai KJ, et al: Multiple parallel skin markers for minimal incision lumbar disc surgery; a technical note. BMC Musculoskeletal Disorders 2004, 5:8.

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