Radiation Exposure to the Surgeon During Ultrasound-Assisted Transforaminal Percutaneous Endoscopic Lumbar Discectomy: A Prospective Study

Wu, Ruo-bin; Liao, Xuqiang; Xia, Hong

doi:10.1016/j.wneu.2017.03.050

Cited by 23 publications

(15 citation statements)

References 24 publications

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“…In terms of radiation exposure during surgery, a prospective study showed that a surgeon should perform no more than 291 procedures [23]. PETD is associated with more radiation exposure than PEID [24], reflecting the longer operative time caused by puncture difficulties, particularly in patients with high cristae iliacae, narrow foramina, or large facet joints. Radiation exposure increases with the operative time.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous endoscopic transforaminal discectomy precedes interlaminar discectomy in the efficacy and safety for lumbar disc herniation

Chen

2019

Bioscience Reports

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We searched several databases from the times of their inception to 20 December 2018. Randomized controlled trials and cohort studies that compared percutaneous endoscopic transforaminal discectomy (PETD) with percutaneous endoscopic interlaminar discectomy (PEID) were identified. We used a random-effects model to calculate the relative risks (RRs) of, and standardized mean differences (SMDs) between the two techniques, with 95% confidence intervals (CIs). Twenty-six studies with 3294 patients were included in the final analysis. Compared with PEID, PETD reduced the short-term (SMD −0.68; 95% CI −1.01, −0.34; P=0.000) and long-term (SMD −0.47; 95% CI −0.82, −0.12; P=0.000) visual analog scale scores, blood loss (SMD −4.75; 95% CI −5.80, −3.71; P=0.000), duration of hospital stay (SMD −1.86; 95% CI −2.36, −1.37; P=0.000), and length of incision (SMD −3.93; 95% CI −5.23, −2.62; P=0.000). However, PEID was associated with a lower recurrence rate (P=0.035) and a shorter operative time (P=0.014). PETD and PEID afforded comparable excellent- and good-quality data, long- and short-term Oswestry disability index (ODI) scores, and complication rates. PETD treated lumbar disc herniation (LDH) more effectively than PEID. Although PETD required a longer operative time, PETD was as safe as PEID, and was associated with less blood loss, a shorter hospital stay, and a shorter incision. PETD is the best option for patients with LDH.

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Section: Discussionmentioning

confidence: 99%

Percutaneous endoscopic transforaminal discectomy precedes interlaminar discectomy in the efficacy and safety for lumbar disc herniation

Chen

2019

Bioscience Reports

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“…Minimally invasive spine surgery and needle-based interventional spine procedures still typically depend on ionizing radiation for localization and guidance in placing the equipment, 15 although different strategies have been adopted to reduce medical staff and patient exposure to radiation as well as to reduce operating time, such as ultrasound-assisted TF-PELD 16 and preoperative location methods. 17 It is known that among various discectomy techniques, the radiation dose is greater on PELD and other MISS when compared with open surgery.…”

Section: Discussionmentioning

confidence: 99%

Radiation Exposure during Percutaneous Endoscopic Lumbar Discectomy: Interlaminar versus Transforaminal

2019

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Objective Percutaneous endoscopic lumbar discectomy (PELD) relies heavily on fluoroscopy guidance; therefore, medical staff exposure to radiation has become an important issue. The purpose of this study was to determine the radiation dose and the amount of time to which the surgeons are exposed during PELD and to compare both parameters in the transforaminal (TF) and interlaminar (IL) approaches. Although they are considerably different, they may be wrongly considered together. Methods A retrospective evaluation of the last 20 PELD performed by the authors is presented. Patients were distributed in 2 groups. Six (1F, 5M) patients were submitted to IL-PELD and 14 (6F, 8M) to TF-PELD. Fluoroscopy reports were obtained from patients' records, all performed with the same C-Arm device and software mode. Groups were compared using unpaired t-test. Results The IL group showed an average radiation exposure of 8.37 ± 4.21 mGy and duration of 11.1 ± 5.45 seconds, while the TF group showed an average radiation exposure of 28.92 ± 7.56 mGy and duration of 42 ± 16.64 seconds. The p-value for radiation was 0.0000036, and for time it was 0.00027. Conclusions Interlaminar PELD requires a lower radiation dose and a shorter amount of exposure than TF-PELD. Studies that concern radiation required for minimally-invasive spine surgeries should consider the PELD approaches separately.

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“…Por lo tanto, la diferencia del tiempo medio de radioscopia puede conducir a la diferencia de la dosis media de radiación. 13 Pero debido a las limitaciones de la estructura ósea, la profundidad de las estructuras espinales y el estrecho campo de visión, la ecografía no puede reemplazar completamente a la radioscopia. 13 Los métodos por imágenes de dosis baja pulsada, la educación sanitaria y del paciente, la tecnología para reducir la exposición a la radiación y el uso de modalidades alternativas de obtención de imágenes computarizadas antes de la cirugía podrían promover medidas de seguridad esenciales para reducir la exposición ocupacional a la radiación.…”

Section: Discussionunclassified

“…13 Pero debido a las limitaciones de la estructura ósea, la profundidad de las estructuras espinales y el estrecho campo de visión, la ecografía no puede reemplazar completamente a la radioscopia. 13 Los métodos por imágenes de dosis baja pulsada, la educación sanitaria y del paciente, la tecnología para reducir la exposición a la radiación y el uso de modalidades alternativas de obtención de imágenes computarizadas antes de la cirugía podrían promover medidas de seguridad esenciales para reducir la exposición ocupacional a la radiación. 1 Algunas de ellas, como el uso de equipos de radioscopia tipo arco en C con brazo en L, emitieron menor radiación que el resto de los equipos que no lo utilizan.…”

Section: Discussionunclassified

Incidencia de la exposición a los rayos X en cirugías de columna. [Incidence of X-rays exposure in spinal surgeries.]

Bazán

Muscia²,

Cano³

et al. 2019

Rev. Asoc. Arg. Ort. y Traumatol

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Introducción: El control radioscópico intraoperatorio es una práctica cada vez más frecuente, que no está libre de eventos adversos para el personal de la salud.Objetivos: Conocer la tasa de uso de radioscopia en la cirugía vertebral, reconocer las medidas de control, evaluar la asimilación del cirujano a los elementos de protección y analizar los eventos adversos en estos profesionales.Materiales y Métodos: Se envió, por correo electrónico, a cirujanos espinales, una encuesta de 17 preguntas de opciones múltiples.Resultados: Se recibieron 55 encuestas. El 87% se dedicaba a la columna, en más del 60% de sus prácticas. El arco en C es el método más utilizado para el control final, en forma pulsátil. Solo el 31% controla el tiempo real. El delantal plomado de una pieza es el método más utilizado, pero se desconoce cuándo se debe reemplazar. La mitad utiliza más de un elemento. Siete casos de trastornos visuales, 5 patologías tiroideas, 3 dermatitis y 2 casos de infertilidad. Tres cirujanos fueron operados por nódulos tiroideos, cataratas o neoplasia.Conclusiones: El control radioscópico intraoperatorio es una práctica frecuente en la cirugía espinal. El delantal plomado de una pieza es el método más utilizado y, muchas veces, se lo combina, pero se desconoce cuándo se deben renovar los plomados. Uno de cada tres cirujanos presentaron las patologías evaluadas y 3, cirugías relacionadas. Así queda en evidencia la protección y el control escasos que existen en los cirujanos especialistas, acompañados de una falta de protocolización que deja a la deriva este control. AbstractBackground: Intraoperative radiographic control (IRC) is an increasingly common practice, but it causes certain adverse events for healthcare providers.Objectives: To measure the use of fluoroscopy in spinal surgery, recognize control measures, evaluate assimilation of protection elements by surgeons, and analyze adverse events for spinal surgeons.Materials and Methods: A survey of 17 multiple-choice questions was e-mailed to spinal surgeons.Results: 55 surveys were answered. More than 60% of surgeons were spinal surgeons. The C-arm is the most widely used machine for final control by pulsating X-rays. Real-time controls are carried out in 31% of cases. One-piece leaded aprons are the most commonly used method, but it is unknown when they should be replaced. Half of the respondents uses more than one protection element. There were seven cases of vision changes, 5 of thyroid disorders, 3 of dermatitis, and 2 of infertility. Three surgeons required surgery for thyroid nodules, cataracts or neoplasm.Conclusions: IRC is a common practice in spinal surgery. One-piece leaded aprons are the most commonly used method and they are often combined with other elements, but it is not known when aprons must be replaced. One in 3 surgeons suffered from the studied conditions, and there were 3 related surgeries. Lack of adequate protection and control is a reality for specialist surgeons, together with a lack of protocols, making this an unregulated issue.

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Radiation Exposure to the Surgeon During Ultrasound-Assisted Transforaminal Percutaneous Endoscopic Lumbar Discectomy: A Prospective Study

Cited by 23 publications

References 24 publications

Percutaneous endoscopic transforaminal discectomy precedes interlaminar discectomy in the efficacy and safety for lumbar disc herniation

Percutaneous endoscopic transforaminal discectomy precedes interlaminar discectomy in the efficacy and safety for lumbar disc herniation

Radiation Exposure during Percutaneous Endoscopic Lumbar Discectomy: Interlaminar versus Transforaminal

Incidencia de la exposición a los rayos X en cirugías de columna. [Incidence of X-rays exposure in spinal surgeries.]

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