Decreasing Radiation Emission in Minimally Invasive Spine Surgery Using Ultra-Low-Radiation Imaging with Image Enhancement: A Prospective Cohort Study

Jakub Godzik; Gautam Nayar; William D Hunter; Luis M Tumialán

doi:10.1016/j.wneu.2018.10.150

Decreasing Radiation Emission in Minimally Invasive Spine Surgery Using Ultra-Low-Radiation Imaging with Image Enhancement: A Prospective Cohort Study

World Neurosurg. 2019 Feb:122:e805-e811. doi: 10.1016/j.wneu.2018.10.150. Epub 2018 Nov 1.

Authors

Jakub Godzik¹, Gautam Nayar², William D Hunter³, Luis M Tumialán⁴

Affiliations

¹ Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
² Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA.
³ Department of Neurosurgery, CaroMont Health Regional Medical Center, Gastonia, North Carolina, USA.
⁴ Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA; Spine Group Arizona, HonorHealth, Greenbaum Surgical Specialty Hospital, Scottsdale, Arizona, USA. Electronic address: [email protected].

PMID: 30391598
DOI: 10.1016/j.wneu.2018.10.150

Abstract

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.

Keywords: Lateral lumbar interbody fusion; Lateral transpsoas interbody fusion; Minimally invasive spine surgery; Occupational risk; Percutaneous screw; Radiation emission; Transforaminal interbody fusion.

MeSH terms

Aged
Cohort Studies
Female
Humans
Image Enhancement / methods*
Image Enhancement / standards
Lumbar Vertebrae / diagnostic imaging
Lumbar Vertebrae / surgery
Male
Middle Aged
Minimally Invasive Surgical Procedures / methods*
Minimally Invasive Surgical Procedures / standards
Neurosurgeons / standards
Occupational Exposure / prevention & control*
Occupational Exposure / standards
Pedicle Screws / standards
Prospective Studies
Radiation Dosage*
Radiation Exposure / prevention & control*
Radiation Exposure / standards
Spinal Fusion / methods
Spinal Fusion / standards