Radiation Exposure to the Spine Surgeon During Fluoroscopically Assisted Pedicle Screw Insertion

Rampersaud, Y. Raja; Foley, Kevin T.; Shen, Alfred C.; Williams, Seth K.; Solomito, Matthew J.

doi:10.1097/00007632-200010150-00016

Cited by 497 publications

(292 citation statements)

References 25 publications

Supporting

Mentioning

270

Contrasting

Unclassified

Order By: Relevance

“…Various methods such as free hand technique, Penfield outside-in technique, under C-arm control, computer assisted navigational surgery and stereotectic surgery, etc., to put the pedicle screw have been described in the literature [20,22,29]. The use of intra-operative fluoroscopy for placement of pedicle screws has resulted in prolonged fluro time and radiation exposure to the surgical personnel and patient [32]. However, we have found that free-hand technique is relatively easy to learn and is as accurate [22] as the other methods, which were implemented in our study.…”

Section: Introductionmentioning

confidence: 80%

Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique

et al. 2008

View full text Add to dashboard Cite

It is a retrospective analytic study of 1,009 transpedicular screws (689 thoracic and 320 lumbosacral), inserted with free-hand technique in neuromuscular scoliosis using postoperative CT scan. The aim of paper was to determine the accuracy and safety of transpedicular screw placement with free-hand technique in neuromuscular scoliosis and to compare the accuracy at different levels in such population. All studies regarding accuracy and safety of pedicle screw in scoliosis represent idiopathic scoliosis using various techniques such as free-hand, navigation, image intensifier, etc., for screw insertion. Anatomies of vertebrae and pedicle are distorted in scoliosis, hence accurate and safe placement of pedicle screw is prerequisite for surgery. Between 2004 and 2006, 37 consecutive patients, average age 20 years (9-44 years), of neuromuscular scoliosis were operated with posterior pedicle screw fixation using free-hand technique. Accuracy of pedicle screws was studied on postoperative CT scan. Placement up to 2 mm medial side and 4 mm lateral side was considered within-safe zone. Of the 1,009 screws, 273 screws were displaced medially, laterally or on the anterior side showing that 73% screws (68% in thoracic and 82.5% in lumbar spine) were accurately placed within pedicle. Considering the safe zone, 93.3% (942/1009, 92.4% in thoracic and 95.3% in lumbar spine) of the screws were within the safe zone. Comparing accuracy according to severity of curve, accuracy was 75% in group 1 (curve \90°) and 69% in group 2 (curve [90°) with a safety of 94.8 and 91.2%, respectively (P = 0.35). Comparing the accuracy at different thoracic levels, it showed 67, 64 and 72% accuracy in upper, middle and lower thoracic levels with safety of 96.6, 89.2 and 93.1%, respectively, exhibiting no statistical significant difference (P = 0.17). Pedicle screw placement in neuromuscular scoliosis with free-hand technique is accurate and safe as other conditions.

show abstract

Section: Introductionmentioning

confidence: 80%

Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique

et al. 2008

View full text Add to dashboard Cite

show abstract

“…Rampersaud et al [26] studied six cadavers and measured radiation exposure to the surgeon's neck, torso, and dominant hand. The authors reported a dramatic decrease in radiation exposure when the surgeon stood on the contralateral side of the patient as the image source.…”

Section: Location Of Surgeon In the Operating Roommentioning

confidence: 99%

Does Less Invasive Spine Surgery Result in Increased Radiation Exposure? A Systematic Review

Khan

2014

Clinical Orthopaedics &Amp; Related Research

100

View full text Add to dashboard Cite

show abstract

“…Currently, established guidelines recommend monitoring for personnel who are exposed to greater than 10% of the maximum permissible annual whole-body dose. 21,28,29 Given a permissible whole--body dose of 5000 mrem per year, the levels of radiation exposure documented in this study would place many spine surgeons above this 10% limit.…”

Section: Descriptores: Fluoroscopía Tornillos óSeos; Columna Vertebrmentioning

confidence: 92%

Reduction in Radiation (Fluoroscopy) While Maintaining Safe Placement of Pedicle Screws During Lumbar Spine Fusion

Chaput

George²,

Samdani

et al. 2012

Spine

View full text Add to dashboard Cite

Objective: The purpose of this study is to report the results using PediGuard (electrical conductivity device) to reduce radiation exposure while drilling the pilot hole for pedicle screw placement. Method: Eighteen patients diagnosed with a degenerative lumbar spine, that required a posterior spinal fusion. Average age of the patients were 55 ± 12 years. Patients received postoperative CT scans of all screws. Scans were reviewed by an independent reviewer grading 'in' < 2 mm of breach , or 'out' > 2 mm of breach. In a randomized fashion, the surgeon created pilot holes with either his standard technique or by using the PediGuard. Fluoroscopy was used for each drilling as necessary. Once the pilot hole was created, the surgeon inserted titanium screws into the pedicle pilot holes. A total of 78 screws (39 standard probe and 39 PediGuard ) were analyzed. Results: 78 screws (39 standard probe and 39 PediGuard were analyzed. No significant difference in breach rate > 2mm by either method (p=1.000), with one screw out in each group. Fluoroscopy shots averaged 5.2 (range, 0 to 15), average decrease of 2.3 (30%) per screw in the PediGuard group vs. 7.5 (range, 2 to 17) in the standard group (p< .001). Conclusion: This trial to assess pedicle probe location within the pedicle and vertebral body showed the number of fluoroscopy shots were reduced by 30%, compared to a standard probe while maintaining a 97.5% screw placement accuracy.

show abstract

Radiation Exposure to the Spine Surgeon During Fluoroscopically Assisted Pedicle Screw Insertion

Cited by 497 publications

References 25 publications

Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique

Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique

Does Less Invasive Spine Surgery Result in Increased Radiation Exposure? A Systematic Review

Reduction in Radiation (Fluoroscopy) While Maintaining Safe Placement of Pedicle Screws During Lumbar Spine Fusion

Contact Info

Product

Resources

About