Use of henna as a durable pre-operative skin marker for accurate localisation of vertebral level in spine surgery


  • Ankit Thora Department of Orthopaedics, Shalby Hospital, Ahmedabad, Gujarat, India
  • Nishit Bhatnagar Department of Orthopaedics, Lok Nayak Hospital, New Delhi, Delhi, India
  • Anurag Tiwari Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
  • Purushotham Lingaiah Department of Orthopaedics, Lok Nayak Hospital, New Delhi, Delhi, India
  • Nitesh Rustagi Department of Orthopaedics, Guru Gobind Singh Government Hospital, New Delhi, Delhi, India



Henna, Skin marking, Spine surgery, Vertebral localisation


BACKGROUND: Indiscriminate use of intra-operative fluoroscopy can incur harm both to the patient as well as the surgeons. Orthopedic surgeons seldom do in skin marking prior to cleaning and draping of the operative site. This study aims to study the feasibility and utility of pre-operative skin marking with henna in conjunction with marker radiograph.

METHODS: Out of 54 patients undergoing spine surgery, vertebral level localization was done by fluoroscopy in 26 patients. In the rest of the 28 patients, preoperative marker radiograph with steel wires was taken in conjunction with henna line markings on the skin. These were correlated for vertebral level localization. Difference in time taken for vertebral localization by these two methods, and the difference in the number of fluoroscopic images required was observed and recorded.

RESULTS: Approximately 4 minutes were needed for level localization via fluoroscopic technique, whereas the henna marking technique did this in approximately 30 seconds. No adverse effects of henna application were observed during the study.

CONCLUSIONS: The use of preoperative skin marking with henna along with the appropriate marker radiograph can reduce the surgical time and radiation exposure without increasing the chances of a wrong level surgery in the spine.


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