Radiation Exposure to Scrub Nurse, Assistant Surgeon, and Anesthetist in Minimally Invasive Spinal Fusion Surgery Comparing 2D Conventional Fluoroscopy With 3D Fluoroscopy-based Navigation

Abstract

Objective: To compare the radiation exposure with the scrub nurse, assistant surgeon, and anesthetist during minimally invasive transforaminal lumbar interbody fusion using conventional 2-dimensional (2D) fluoroscopy or 3D fluoroscopy-based navigation.Summary of Background Data: Minimally invasive spinal fusion techniques are related to higher radiation exposures compared with open techniques. Especially the routinely exposed surgical staff faces the risks of increased radiation exposure.Methods: In total, 41 patients with planned monosegmental minimally invasive transforaminal lumbar interbody fusion were randomized into the intraoperative imaging techniques 2D fluoroscopy or 3D navigation. Eye lens and film dosemeters were attached to defined locations of the scrub nurse, assistant surgeon, and anesthetist. Mann-Whitney U and Wilcoxon-matched pairs signed-rank test were used to compare dosemeter readings. This study was registered with the German Clinical Trials Register (DRKS00004514). Results:The radiation exposure per surgery was low for the scrub nurse, assistant surgeon, and anesthetist in both the 2D fluoroscopy and 3D navigation groups. The maximum average value of 0.057 ± 0.031 mSv was measured on the unprotected chest of the assistant surgeon and was thus slightly above the lower detection limit of the dosemeters (0.044 mSv). The annual occupational dose limit would be exceeded at the earliest after 571 operations for the unprotected eye lens of the assistant surgeon.Conclusions: Minimally invasive lumbar fusion surgery is possible with comparatively low radiation exposure to the assisting operating room personnel without exceeding the annual maximum occupational radiation exposure. However, there is no definite dose value below which ionizing radiation poses no risk. Consequently, radiation sparing work routines should be strictly followed.

Comparing radiation dose of image-guided techniques in lumbar fusion surgery with pedicle screw insertion; A systematic review

“…If these variables differed between studies of the same research group, no reasons were found to assume that the same patients were included in the studies. Thirty-five studies were included for final analysis, including six RCTs [18] , [19] , [20] , [21] , [22] , [23] , 17 NRCTs [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] and 12 case-series [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] . Inclusions did not lead to disagreement between reviewers.…”

“…Level of evidence was 2 in six studies [18] , [19] , [20] , [21] , [22] , [23] , 3 in 14 studies [ [24] , [25] , [26] , [29] , [30] , [31] , [32] , [33] , [34] , 36 , 37 , 39 , 41 , 42 ] and 4 in 15 studies [ 27 , 28 , 35 , 38 , 40 , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] ]. Risk of bias assessment was summarized in of additional file 3.…”

“…Study characteristics of the 35 included studies are summarized per image-guided technique in to 5 of additional files 4 to 8. The included studies are divided in five groups, resulting in 25 studies reporting on conventional C-arm [ [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [28] , [29] , [30] , [31] , 33 , 34 , 36 , 39 , 40 , [42] , [43] , [44] , [45] , [47] , [48] , [49] , 53 ], eight studies on C-arm navigation [ 18 , 23 , 25 , 26 , 33 , 34 , 40 , 52 ], four studies on C-arm robotic [ 19 , 20 , 35 , 36 ], nine studies on O-arm navigation [ 27 , 30 , [37] , [38] , [39] , 41 , 46 , 50 , 51 ] and three studies on O-arm robotic [ 27 , 37 , 38 ]. Fourteen studies described two different image-guided techniques whose results were reported separately.…”

History and Evolution of the Minimally Invasive Transforaminal Lumbar Interbody Fusion

“…Furthermore, it has been suggested that cone-beam CT imaging may provide simply a nonsignificant reduction in surgeon exposure while unnecessarily increasing radiation exposure to the patient. 70…”

“…Though cone-beam CT imaging systems provide reductions in surgeon radiation exposure relative to traditional fluoroscopy [ 69 ], standard fluoroscopy remains most prominent in MIS-TLIF procedures. Furthermore, it has been suggested that cone-beam CT imaging may provide simply a nonsignificant reduction in surgeon exposure while unnecessarily increasing radiation exposure to the patient [ 70 ].…”