Introduction: Radiation exposure during minimally invasive (MIS) spine fusion is one of the paramount concerns for surgeons. While the benefits of MIS are lauded by many, there is a significant amount of radiation exposure to surgeon and operating room (OR) personnel. Our goal with this work was to see if by using ultra-low dose radiation settings coupled with image enhancement, this exposure could be minimized.
Methods: An IRB approved, prospective, internally randomized controlled trial was performed comparing ultra-low dose settings coupled with image enhancement software to conventional fluoroscopic imaging (Figure 1). In this study, each patient served as their own control, randomly assigning one side of MIS-TLIF for cannulation and k-wire placement using each imaging modality. Further, the case was also randomly divided into screw placement and cage placement/final images to allow further comparisons amongst patients. Radiation production from the c-arm fluoroscope as well as radiation exposure to all operating room personnel were recorded.
Results: 24 patients were randomly assigned to undergo a single level MIS-TLIF. In no case was low radiation imaging abandoned, and no patient had a neurologic decline or required hardware repositioning. Ultra-low radiation imaging resulted in a 75.5% decrease in total radiation production by the c-arm fluoroscope. Everyone in the operating room: the physician, scrub nurse, circulator, and anesthesiologist, all benefited with 61.6-83.5% reduction in radiation exposure during cannulation and k-wire placement to screw insertion aided by ultra-low radiation imaging. In every case but the anesthesiologist dose, this was statistically significant (p<0.05). This benefit required no additional time (p=0.78 for k-wire placement).
Conclusions: Ultra-low radiation imaging, when aided by image enhancement software, affords the ability for all parties in the operating room to substantially decrease their radiation exposure compared to standard-dose c-arm fluoroscopy without adding additional time or an increased complication rate.
Patient Care: Increased radiation exposure during minimally invasive spine surgery has short and long-term health effects including rashes, burns, and increased incidence of malignant tumors. By demonstrating a safe and clinically efficacious method of lowering intraoperative radiation, we can reduce the detrimental consequences of this exposure.
Learning Objectives: 1) MIS-TLIF can be safely performed using ultra-low dose radiation imaging (ULRI)
2) Ultra-low dose radiation settings provide significant reduction in radiation exposure to all operating room personnel
3) Use of ultra-low dose radiation imaging does not significantly increase operation time