Intraoperative CT for lumbar fusion is not associated with improved short- or long-term complication profiles

Crawford, Alexander M; Striano, Brendan M; Lightsey, Harry M.; Gong, Jonathan; Simpson, Andrew K.; Schoenfeld, Andrew J.

doi:10.1016/j.spinee.2023.02.016

Cited by 3 publications

(3 citation statements)

References 28 publications

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“…Crawford conducted a registry review of two tertiary and two community hospitals comparing one-level fusions performed for spondylolisthesis with navigated and fluoroscopically-assisted instrumentation. No differences were seen in the 90-day adverse events and 3-year revision rates between groups [11]. Similarly, Sielatychi reviewed the evidence for navigation and robotics, emphasizing that, to date, no conclusive evidence has supported that navigation has any measurable impact on patient outcomes [12].…”

Section: Robotics Navigation and Augmented Realitymentioning

confidence: 99%

Emerging Technologies within Spine Surgery

Foley,

Hardacker,

McCarthy

2023

Life

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New innovations within spine surgery continue to propel the field forward. These technologies improve surgeons’ understanding of their patients and allow them to optimize treatment planning both in the operating room and clinic. Additionally, changes in the implants and surgeon practice habits continue to evolve secondary to emerging biomaterials and device design. With ongoing advancements, patients can expect enhanced preoperative decision-making, improved patient outcomes, and better intraoperative execution. Additionally, these changes may decrease many of the most common complications following spine surgery in order to reduce morbidity, mortality, and the need for reoperation. This article reviews some of these technological advancements and how they are projected to impact the field. As the field continues to advance, it is vital that practitioners remain knowledgeable of these changes in order to provide the most effective treatment possible.

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Section: Robotics Navigation and Augmented Realitymentioning

confidence: 99%

Emerging Technologies within Spine Surgery

Foley,

Hardacker,

McCarthy

2023

Life

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“…The coming integration of augmented reality5 would be expected to further perpetuate this trend. Although it is important to understand whether such technologies improve the accuracy and outcomes of instrumentation,2,5–9,36 it is also critically important to understand how the increased use of intraoperative CT itself may affect patients on a population level. Prior investigations have sought to determine whether intraoperative CT increases radiation exposure compared with conventional radiography 12–14.…”

Section: Discussionmentioning

confidence: 99%

“…Although prior studies have tested whether such advances indeed make instrumentation safer, 2,[5][6][7][8][9] the rapid increase in CT utilization itself merits deeper investigation. Specifically, CT (like any form of ionizing radiation) is known to be carcinogenic.…”

mentioning

confidence: 99%

Projected Lifetime Cancer Risk Associated with Intraoperative Computed Tomography for Lumbar Spine Surgery

Crawford

Striano

Giberson-Chen

et al. 2023

Spine

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Study Design. Retrospective cross-sectional study. Objective. (1) To determine the incremental increase in intraoperative ionizing radiation conferred by computed tomography (CT) as compared with conventional radiography; and (2) to model different lifetime cancer risks contextualized by the intersection between age, sex, and intraoperative imaging modality. Summary of Background Data. Emerging technologies in spine surgery, like navigation, automation, and augmented reality, commonly utilize intraoperative CT. Although much has been written about the benefits of such imaging modalities, the inherent risk profile of increasing intraoperative CT has not been well evaluated. Materials and Methods. Effective doses of intraoperative ionizing radiation were extracted from 610 adult patients who underwent single-level instrumented fusion for lumbar degenerative or isthmic spondylolisthesis from January 2015 through January 2022. Patients were divided into those who received intraoperative CT (n=138) and those who underwent conventional intraoperative radiography (n=472). Generalized linear modeling was utilized with intraoperative CT use as a primary predictor and patient demographics, disease characteristics, and preference-sensitive intraoperative considerations (e.g. surgical approach and surgical invasiveness) as covariates. The adjusted risk difference in radiation dose calculated from our regression analysis was used to prognosticate the associated cancer risk across age and sex strata. Results. (1) After adjusting for covariates, intraoperative CT was associated with 7.6 mSv (interquartile range: 6.8–8.4 mSv; P<0.001) more radiation than conventional radiography. (2) For the median patient in our population (a 62-year-old female), intraoperative CT use increased lifetime cancer risk by 2.3 incidents (interquartile range: 2.1–2.6) per 10,000. Similar projections for other age and sex strata were also appreciated. Conclusions. Intraoperative CT use significantly increases cancer risk compared with conventional intraoperative radiography for patients undergoing lumbar spinal fusions. As emerging technologies in spine surgery continue to proliferate and leverage intraoperative CT for cross-sectional imaging data, strategies must be developed by surgeons, institutions, and medical technology companies to mitigate long-term cancer risks.

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