More is less: image enhancement technology reduces radiation exposure during anterior lumber interbody fusion

Background context: Fluoroscopy and radiation exposure occur during anterior lumbar interbody fusion (ALIF). Image enhancement technology is available that can potentially reduce radiation exposure.

Purpose: The purpose of this study is to evaluate radiation exposure and fluoroscopy times comparing standard fluoroscopy (FL) with a low dose image enhancement platform (LD).

Study design: Retrospective review of prospectively maintained database.

Patient sample: Consecutive patients undergoing ALIF with either standard fluoroscopy or low dose image enhancement technology.

Outcome measures: Radiation dispersion and fluoroscopy times in ALIF patients with standard fluoroscopy and low dose image enhancement technology.

Methods: A retrospective review of a prospective database on consecutive patients who have undergone ALIF, stratified into 2 groups: subjects with standard fluoroscopy (FL), and low dose fluoroscopy with image enhancement technology (LD).

Results: A total of 487 ALIF patients were included (FL: 372 vs. LD: 115). LD patients were significantly older (66 vs. 60 years), with more deformity cases (28% vs. 12%), and less degenerative cases (71% vs. 87%), all p<.05; no differences in sex, BMI, or the number of levels operated on between groups. Fluoroscopy time (sec) was significantly higher in LD (51.4 vs. 45.5), with a statistically significant reduction in radiation (mGy) compared to FL (23.3 vs. 48.2), both p<.05. Furthermore, the results showed that radiation dispersion is increasingly reduced as fluoroscopy time increases in LD compared to FL (12%, 56%, and 65% reduction in radiation dispersion for fluoroscopy time <30 sec, between 30 to 60 sec, and >60 sec, respectively).

Conclusions: The use of low dose fluoroscopy with image enhancement technology significantly reduces the cumulative dose of radiation during ALIF compared to standard dose fluoroscopy. Also, radiation dispersion increasingly decreases as fluoroscopy time increases using low dose image enhancement technology. Low dose image enhancement technology improves the safety profile of ALIF for patients and operating room staff.