Abstract Objective Discuss the accuracy and advantages and disadvantages of palpation positioning and ultrasound-assisted positioning of the thoracic vertebral body level. Methods A total of 48 patients undergoing elective spinal surgery were selected, including 19 males and 29 females. The ASA classification was Ⅰ～Ⅲ. After spinous process of C7 was identified by palpation by a skilled anesthesiologist, palpation was performed to the tail side until spinous process of T7 was identified and marked and the position of T7a was determined according to this mark. Later, another anesthesiologist skilled in spinal ultrasound used a low-frequency convex array probe to place the coronal scan at the level of the cervical spine up and down to determine the C7 spinous process position. Ultrasound caudal scan to determine the position of the T1 spinous process and transverse process and mark, and then scan to determine the position of the T7 transverse process, and mark T7b. Finally, the spine surgeon uses the C-arm machine to take images to determine the exact position of T7 to determine whether the positioning of T7a and T7b is correct. Results The accuracy rate of ultrasound-assisted localization was significantly higher than that of body surface landmark palpation, 85.4% vs 52.1% （P＜0.05）. Compared with the body surface mark palpation method, the ultrasound-assisted positioning method reduces the influence of individual differences on the positioning; The influence of BMI and age on the accuracy of the two positioning methods is not statistically significant. Conclusion Ultrasound-assisted localization is superior to body surface landmark palpation.