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  • Title: Decreasing Radiation Emission in Minimally Invasive Spine Surgery Using Ultra-Low-Radiation Imaging with Image Enhancement: A Prospective Cohort Study.
    Author: Godzik J, Nayar G, Hunter WD, Tumialán LM.
    Journal: World Neurosurg; 2019 Feb; 122():e805-e811. PubMed ID: 30391598.
    Abstract:
    BACKGROUND: Visualization of the anatomy in minimally invasive surgery (MIS) of the spine is limited and dependent on radiographic imaging, leading to increased radiation exposure to patients and surgical staff. Ultra-low-radiation imaging (ULRI) with image enhancement is a novel technology that may reduce radiation in the operating room. The aim of this study was to compare radiation emission between standard-dose and ULRI fluoroscopy with image enhancement in patients undergoing MIS of the spine. METHODS: This study prospectively enrolled 60 consecutive patients who underwent lateral lumbar interbody fusion, lateral lumbar interbody fusion with percutaneous pedicle screws, or MIS transforaminal lumbar interbody fusion. Standard-dose fluoroscopy was used in 31 cases, and ULRI with image enhancement was used in 29 cases. All imaging emission and radiation doses were recorded. RESULTS: Radiation emission per level was significantly less with ULRI than with standard-dose fluoroscopy for lateral lumbar interbody fusion (36.4 mGy vs. 119.8 mGy, P < 0.001), per screw placed in lateral lumbar interbody fusion (15.4 mGy per screw vs. 47.1 mGy per screw, P < 0.001), and MIS transforaminal lumbar interbody fusion (24.4 mGy vs. 121.6 mGy, P = 0.003). These differences represented reductions in radiation emission of 69.6%, 67.3%, and 79.9%. Total radiation doses per case were also significantly decreased for the transpsoas approach by 68.8%, lateral lumbar interbody fusion with percutaneous pedicle screws by 65.8%, and MIS transforaminal lumbar interbody fusion by 81.0% (P ≤ 0.004). CONCLUSIONS: ULRI with image enhancement has the capacity to significantly decrease radiation emission in minimally invasive procedures without compromising visualization of anatomy or procedure safety.
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