Comparison of Effective Dose of Radiation During Pedicle Screw Placement Using Intraoperative Computed Tomography Navigation Versus Fluoroscopy in Children With Spinal Deformities

Richerand, Alejandro Dabaghi; Christodoulou, Emmanuel; Li, Ying; Caird, Michelle S.; Jong, Nahbee; Farley, Frances A.

doi:10.1097/bpo.0000000000000493

Cited by 42 publications

(37 citation statements)

References 14 publications

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“…To date, there have been only a few reports in the literature with an analysis of radiation dose of the O-arm system: several were performed on phantoms or cadavers 1,14,21,29 or during a balloon kyphoplasty procedure, 23 while only 2 studies analyzed radiation doses during an instrumented spinal procedure. 5,25 For this reason, the authors are presenting data regarding the radiation exposure of the patients, surgeon, and operative team in a consecutive series of patients undergoing instrumented spine surgery.…”

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confidence: 99%

Radiation exposure in spine surgery using an image-guided system based on intraoperative cone-beam computed tomography: analysis of 107 consecutive cases

Costa¹,

Tosi

Attuati³

et al. 2016

SPI

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OBJECTIVE The O-arm system in spine surgery allows greater accuracy, lower rate of screw misplacement, and reduced surgical time. Some concerns have been postulated regarding the radiation doses to patients and surgeons. To the best of the authors' knowledge, most of the studies in the literature were performed with the use of phantoms. The authors present data regarding radiation exposure of the surgeon and operating room (OR) staff in a consecutive series of patients undergoing spine surgery. METHODS Radiation exposure data were collected in a series of 107 patients who underwent spine surgery using the O-arm system. The doses received by the surgeon and the staff were collected using electronic dosimeters. RESULTS All patients underwent 1–3 scans. The mean radiation dose to the patients was 5.15 mSv (range 1.48–7.64 mSv). The mean dose registered for the scan operator was 0.005 μSv (range 0.00–0.03 μSv) while the other members of the surgical team positioned outside the OR received 0 μSv. CONCLUSIONS The O-arm system exposes patients to a higher radiation dose than standard fluoroscopy. However, considering the clear advantages of this system, this adjunctive dose can be considered acceptable. Moreover, the effective dose to the patient can be reduced using collimation or minimizing the parameters of the O-arm system used in this paper. The exposure to operators is essentially negligible when radioprotective garments and protocols are adopted as recommended by the International Commission on Radiological Protection.

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mentioning

confidence: 99%

Radiation exposure in spine surgery using an image-guided system based on intraoperative cone-beam computed tomography: analysis of 107 consecutive cases

Costa¹,

Tosi

Attuati³

et al. 2016

SPI

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“…No clinical complications were encountered, which is similar to the symptomatic breach rate of 0.2% reported with lumbar percutaneous pedicle screw placement using 3-D stereotactic navigation. 30 Even though surgeon's radiation exposure and pedicle breach are markedly reduced with 3-D CT or fluoroscopy-navigation methods, they have a significant equipment cost limitation, incapability to get real-time location of guide wires in the vertebral body, radiation exposure to the patient is increased 31 and clinical outcome benefits have not been definitively demonstrated.…”

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confidence: 99%

Fluoroscopy-guided pedicle screw accuracy with a mini-open approach: a tomographic evaluation of 470 screws in 125 patients

et al. 2015

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“…Die durchschnittliche intraoperative Strahlenexposition bei CAN betrug 1,48-1,11 mSv und war um 4,6-bis 6,2-fach höher als die durchschnittlich gemessene effektive Dosis in unserer Studie [1,3]. Durchschnittlich wurden bei Dabaghi et al 13 [18].…”

Section: Daten Zur Strahlenbelastung In Der Literaturunclassified

“…Bei Patienten mit Adipositas (Body-Mass-Index > 30 kg/m 2 ) berechneten Dabaghi et al eine deutlich höhere intraoperative Strahlenbelastung (3,0-8,5 mSv) in CAN im Vergleich zu normalgewichtigen gleichaltrigen Patienten (Mittelwert: 0,99 mSv). Beim Vergleich der Patienten mit einer Korrekturspondylodese in FH fiel der Unterschied der intraoperativen Strahlenbelastung von den Patienten mit Adipositas (0,25-0,6 mSv) zu den normalgewichtigen Patienten (Mittelwert: 0,29 mSv) geringer aus [3]. Durch dieses Beispiel wird ersichtlich, dass die intraoperative Strahlenexposition ein riskanter und nicht zu unterschätzender Faktor in der Skoliosechirurgie ist.…”

Section: Bedeutung Der Strahlenbelastung Für Den Patientenunclassified

Intraoperative Radiation Exposure for Patients with Double-Curve Idiopathic Scoliosis in Freehand-Technique in Comparison to Fluoroscopic- and CT-Based Navigation

et al. 2020

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Background In the operative treatment of idiopathic scoliosis, posterior correction and fusion in freehand technique is a proven procedure and is frequently performed. Malpositioned pedicle screws can result in serious neurovascular complications. Intraoperative fluoroscopy and neurophysiological measurements are performed to ensure the correct position of pedicle screws. Newer procedures with fluoroscopic- and computertomographic-assisted navigation are advertised as less dangerous and with a more accurate screw position. Hypothesis Is the freehand technique used in the surgical treatment of idiopathic scoliosis safer than other methods with regard to complications caused by screw malposition and intraoperative radiation exposure? Material and Methods Register data of 34 consecutive idiopathic scoliosis patients with two structural curves (Lenke 3 and 6) were collected prospectively in our scoliosis center and were retrospectively analyzed. The following parameters were evaluated: total radiation product, time of fluoroscopy, number of fused segments, time of operation, blood loss, screw-related complications and number of instrumented pedicle screws. All values were given as mean ± standard deviation and statistically analyzed. Finally, our data were compared on accuracy of screw placement and radiation exposure to data from literature with screw placement under navigation. Results Average age at the time of surgery was 23.6 ± 12 years. The average thoracic curve was 69.2 ± 14.2° preoperatively and 21.7 ± 12.8° postoperatively (correction 69.9%), the average lumbar curve was 64.3° ± 10.8° preoperatively and corrected to 15.6 ± 10.4° postoperatively (correction 76.2%). The total radiation product per patient was 145.7 ± 86.1 cGy*cm², the time of fluoroscopy 31.7 ± 23.5 s (11.5 segments), the time of operation 267.2 ± 64.1 min and the blood loss 700.4 ± 522.3 ml. A total of 803 pedicle screws were placed. No screw-associated complications were detected in the entire collective. The comparison of our data with freehand placement of pedicle screws to literature data showed a noticeable higher radiation exposure for the patient during fluoroscopic- and computertomographic-assisted navigation. Discussion The results showed that positioning of pedicle screws with freehand technique in patients with idiopathic scoliosis is accompanied with considerably lower intraoperative radiation exposure compared to fluoroscopic- or computertomographic-assisted navigation. An increased radiation exposure of these typically young patients is associated with an increased long-term risk for the occurrence of radiation-induced malignant diseases. With appropriate surgical experience, placement of pedicle screws in freehand technique is safe and effective and with similar accuracy than screws placed under navigation, but produces significantly less radiation exposure to the patients.

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Comparison of Effective Dose of Radiation During Pedicle Screw Placement Using Intraoperative Computed Tomography Navigation Versus Fluoroscopy in Children With Spinal Deformities

Abstract: Level II.

Cited by 42 publications

References 14 publications

Radiation exposure in spine surgery using an image-guided system based on intraoperative cone-beam computed tomography: analysis of 107 consecutive cases

Radiation exposure in spine surgery using an image-guided system based on intraoperative cone-beam computed tomography: analysis of 107 consecutive cases

Fluoroscopy-guided pedicle screw accuracy with a mini-open approach: a tomographic evaluation of 470 screws in 125 patients

Intraoperative Radiation Exposure for Patients with Double-Curve Idiopathic Scoliosis in Freehand-Technique in Comparison to Fluoroscopic- and CT-Based Navigation

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