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  • Decreased Radiation Exposure to Patients and OR Staff using Fully Navigated Minimally Invasive Transforaminal Lumbar Interbody Fusion Compared to Fluoroscopic Guided Counterpart

    Final Number:

    Jean-Pierre Mobasser MD; Ian Kainoa White MD; Jacob B. Archer MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) has been celebrated as a technique for decreasing patient’s post-operative pain, decreased blood loss in the OR, and shorter hospital stays. It has come under criticism recently due to the perception that the radiation exposure to the patient, surgeon, and operating room staff are increased in comparison to its open counterpart. This study assesses radiation exposure between the fully navigated versus conventional fluoroscopic MIS TLIF techniques using the C-arm and K-wires

    Methods: Retrospective chart review was completed for the senior author’s 1 and 2 level MIS TLIFs performed consecutively from 2004-2014. The surgeries from 2004-2006 were performed with fluoroscopy, and the surgeries from 2006-2014, were performed only using neuronavigation. Radiation exposure was recorded at the end of each case by the radiology department.

    Results: Over this time period 391 single level and 200, 2 level navigated MIS TLIFs were performed. Over the same period 71 single level and 26, 2 level MIS TLIFs were performed using conventional fluoroscopy. The total radiation dosing per procedure was 86.4 mGy for one level and 89.2 mGy for 2 level neuronavigated TLIF. For conventional fluoroscopy, there was 121.8 mGy for single level and 182.1 mGy for 2 level TLIF. Both single and 2 level MIS TLIFs met statistical differences in radiation dosing to the patient.

    Conclusions: Fully navigated MIS TLIF provides a viable alternative to the conventional MIS TLIF with decreased radiation exposure to the OR staff, surgeon, and patient.

    Patient Care: This clinical study shows that a MIS TLIF can be performed, while minimizing radiation exposure to the surgeon and operating room staff, and also reducing radiation to the patient compared with traditional fluoroscopic techniques.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1.) Understand the technique utilized that reduces radiation to the patient, surgeon, and operating room staff. 2.) Recognize the value of navigation in minimally invasive spinal fusion.


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