Emerging Technologies in Spinal Surgery: Ultra-Low Radiation Imaging Platforms

Abstract

BACKGROUND Spine surgery has seen tremendous growth in the past 2 decades. A variety of safety, practical, and market-driven needs have spurred the development of new imaging technologies as necessary tools for modern-day spine surgery. Although current imaging techniques have proven satisfactory for operative needs, it is well-known that these techniques have negative consequences for operators and patients in terms of radiation risk. Several mitigating techniques have arisen in recent years, ranging from lead protection to radiation-reducing protocols, although each technique has limits. A hitherto-problematic barrier has been the fact that efforts to diminish radiation emission come at the cost of reduced image quality. OBJECTIVE To describe new ultra-low radiation imaging modalities that have the potential to drastically reduce radiation risk and minimize unacceptable adverse effects. METHODS A literature review was performed of articles and studies that used either of 2 ultra-low radiation imaging modalities, the EOS system (EOS-Imaging S.A., Paris, France) and LessRay (NuVasive, San Diego, CA). RESULTS Both ultra-low radiation imaging modalities reduce radiation exposure in the preoperative and perioperative settings. EOS provides 3-dimensional reconstructive capability, and LessRay offers intraoperative tools that facilitate spinal localization and proper visual alignment of the spine. CONCLUSION These novel radiation-reducing technologies diminish patient and surgeon exposure, aid the surgeon in preoperative planning, and streamline intraoperative workflow.

Development and validation of a practical solution for detecting motion artefacts in the EOS X-ray system

“…Furthermore, numerous quantitative parameters of the spine can be determined, such as the Cobb angle, sagittal vertical axis, pelvic tilt or sacral slope 1 , 3 . Various studies have shown that EOS imaging provides reliable and precise 3D reconstructions of the spine 4 – 7 , that cannot be achieved with conventional X-ray images. Moreover, EOS technology requires only a fraction of the radiation dose of conventional X-rays 1 , 4 , 5–10 times smaller.…”

“…Various studies have shown that EOS imaging provides reliable and precise 3D reconstructions of the spine 4 – 7 , that cannot be achieved with conventional X-ray images. Moreover, EOS technology requires only a fraction of the radiation dose of conventional X-rays 1 , 4 , 5–10 times smaller. However, the recording time can take up to 25 s, which is significantly longer than 1–2 s of conventional X-ray 3 , and during this time, patients have to stand or sit motionless in the device.…”

Commentary: Emerging Technologies in Spinal Surgery: Ultra-Low Radiation Imaging Platforms

“…he authors 1 provide a very nice overview of modern low-dose imaging options available to spine surgeons. The authors discuss one system that is used for preoperative planning and postoperative evaluation, and the authors discuss a low-dose system that is used intraoperatively.…”