Introduction: Surgeon exposure to ionizing radiation during minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) and percutaneous pedicle screw (PPS) placement is a concern due to the potential association with higher rates of thyroid cancer and leukemia. The MinRad arm holds the Jamshiidi needle in place allowing the surgeon to step away from the operative field during PPS placement to reduce surgeon radiation exposure.

Methods: 115 patients with spondylolisthesis were included and reviewed retrospectively from November 2011 to Feb 2014, underwent MI-TLIF with PPS using the MinRad arm. A total of 476 PPS were preformed. Radiation exposure to surgeon and patient were measures and compared with standard techniques for holding Jamshiidi needle during PPS placement.

Results: 78 females and 37 males were included, with a range of age between 20-84 years old (average 63 yo). Levels included L4-5 (n=69 cases (60%)), L5-S1 (n=26 cases (22%)), and L3-4 (n=16 cases (14%)). The MinRad arm was positioned opposite to the surgeon to hold the targeting jamshiidi needle (table I). Flouroscopic time for one level or four PPS placement averaged 37 +/- 9 seconds. Two level 59 +/- 8 seconds (range 28-126 seconds). Surgeons experienced no radiation exposure due to ability to stand away from radiation exposure field and behind radiation shield. Accuracy of pedicle screw placement was enhanced and facilitated based on intra and post-operative plain films and post-operative computer tomography images. Placement of PPS was facilitated using the MinRad arm resulting in shortened operative times averaging 20 minutes.

Conclusions: The MinRad arm is a novel technique and technology for reducing surgeon exposure to radiation while facilitating PPS placement.

Patient Care: Reduction of fluoro time exposure during minimally invasive transforaminal lumbar inter body fusion and percutaneous pedicle screw placement.

Learning Objectives: Awareness of side effect of ionized radiation exposure during minimally invasive fusion techniques. Awareness of technique and technology for reducing radiation exposure during percutaneous pedicle screw placement.

References: 1. Ropper; Maximal Radiation Exposure During Minimally Invasive Spine Surgery?, Neurosurgery, apr, 2011. 2. Butler et al; Techniques to Minimize Intraoperative Radiation Exposure. Seminar in spine surgery; 20:181-185 2008.