Decreasing Radiation Emission in Minimally Invasive Spine Surgery Using Ultra-Low-Radiation Imaging with Image Enhancement: A Prospective Cohort Study.
BACKGROUND: Visualization of the anatomy in minimally invasive surgery (MIS) of the spine is limited and dependent on radiographic imaging, leading to increased radiation exposure to patients and surgical staff. Ultra-low-radiation imaging (ULRI) with image enhancement is a novel technology that may reduce radiation in the operating room. The aim of this study was to compare radiation emission between standard-dose and ULRI fluoroscopy with image enhancement in patients undergoing MIS of the spine.
METHODS: This study prospectively enrolled 60 consecutive patients who underwent lateral lumbar interbody fusion, lateral lumbar interbody fusion with percutaneous pedicle screws, or MIS transforaminal lumbar interbody fusion. Standard-dose fluoroscopy was used in 31 cases, and ULRI with image enhancement was used in 29 cases. All imaging emission and radiation doses were recorded.
RESULTS: Radiation emission per level was significantly less with ULRI than with standard-dose fluoroscopy for lateral lumbar interbody fusion (36.4 mGy vs. 119.8 mGy, P < 0.001), per screw placed in lateral lumbar interbody fusion (15.4 mGy per screw vs. 47.1 mGy per screw, P < 0.001), and MIS transforaminal lumbar interbody fusion (24.4 mGy vs. 121.6 mGy, P = 0.003). These differences represented reductions in radiation emission of 69.6%, 67.3%, and 79.9%. Total radiation doses per case were also significantly decreased for the transpsoas approach by 68.8%, lateral lumbar interbody fusion with percutaneous pedicle screws by 65.8%, and MIS transforaminal lumbar interbody fusion by 81.0% (P ≤ 0.004).
CONCLUSIONS: ULRI with image enhancement has the capacity to significantly decrease radiation emission in minimally invasive procedures without compromising visualization of anatomy or procedure safety.
Medical Subject Headings
Aged; Cohort Studies; Female; Humans; Image Enhancement; Lumbar Vertebrae; Male; Middle Aged; Minimally Invasive Surgical Procedures; Neurosurgeons; Occupational Exposure; Pedicle Screws; Prospective Studies; Radiation Dosage; Radiation Exposure; Spinal Fusion
Digital Object Identifier (DOI)
Godzik, Jakub; Nayar, Gautam; Hunter, William D; and Tumialán, Luis M, "Decreasing Radiation Emission in Minimally Invasive Spine Surgery Using Ultra-Low-Radiation Imaging with Image Enhancement: A Prospective Cohort Study." (2019). Neurosurgery Articles. 741.