Introduction: Transforaminal Lumbar Interbody Fusion (TLIF) is a surgical procedure that stabilizes adjoining vertebrae to facilitate union. It can be performed using minimally invasive techniques that reduce tissue disruption and improve healing times. However, recent systematic reviews highlight the health hazard of radiation exposure using current visualization devices [1]. The goal of the study was to compare the KICK System and standard fluoroscopic guidance

Methods: A case study was conducted between October 2016 and February 2017. 43 TLIF cases were conducted at Holland Hospital in Michigan. Cases comprised 20 (+ 2 pilot) cases with fluoroscopic guidance only (i.e., control), followed by 20 (+1 pilot) KICK System image-guided cases with fluoroscopic guidance (i.e., experimental). This study was limited to 1-level (2 vertebrae) and 2-level (3 vertebrae) cases and subgroup analysis was performed for each level. Mean procedure fluoroscopy time (seconds) and individual screw placement (minutes and seconds per procedure) were analyzed using a student’s t-test between control and KICK System cases.

Results: The patients were between 30-70 years old and comparable between 1-level (control n:13 and KICK System n:13) and 2-level (control n: 7 and KICK System n:7) cases. There was a 65% decrease in mean fluoroscopy time between control (mean: 79.1; SD: 25.0) and KICK System (27.7; 12.5) (65%, p> 0.001) in 1-level cases. Additionally, there was a 72% decrease between control (133; 59.8) and KICK System (37.2; 18.8) (p= 0.00157) in 2-level cases. Placing individual pedicle screws only took significantly more time between 1-level control (3m4s; 1m57s) and KICK System (4m10s; 2m27s) (36%,p= 0.02), but not 2-level control (4m6s; 3m3s) and KICK System (5m5s; 4m14s) (24%,p= 0.26).

Conclusions: Compared to fluoroscopic guidance alone, the KICK System is associated with a significant decrease in mean radiation exposure time.

Patient Care: This research will identify techniques that potentially reduce radiation exposure during TLIF surgery

Learning Objectives: By the conclusion of the session, participants should be able to: 1) Understand the issue of radiation exposure during surgical imaging 2) Identify techniques that mitigate radiation exposure.

References: References [1] R. K. Duffy, S. Goldhahn, A. Matityahu, A. Joeris, P. Richter and F. Gebhard, "The Great Unknown—A systematic literature review about risk associated with intraoperative imaging during orthopaedic surgeries," Injury, p. 1727–1734, 2017.