Impact of body habitus on fluoroscopic radiation emission during minimally invasive spine surgery

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>Minimally invasive spine surgeries (MISSs) have gained immense popularity in the last few years. Concern about the radiation exposure has also been raised. The purpose of this study was to demonstrate the impact of body habitus on the radiation emission during various MISS procedures. The authors also aim to evaluate the effect the surgeon's experience has on the amount of radiation exposure during MISS especially with regard to patient size.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>The authors conducted a retrospective analysis of 332 patients who underwent 387 MISS procedures performed at their institution from January 2010 to August 2013 by a single surgeon. The dose of radiation emission available from the fluoroscopic equipment was recorded from the electronic database. The authors analyzed mainly 3 procedure groups: microdiscectomy/decompression (MiDD, n = 211) and transforaminal lumbar interbody fusion (TLIF) either with unilateral instrumentation (UnTLIF, n = 106) or bilateral instrumentation (BiTLIF, n = 70). The patients in each procedure group were divided into 6 categories based on the WHO criteria for obesity: underweight (body mass index [BMI] &lt; 18.50), normal (18.50–24.99), overweight (25.00–29.99), Class 1 obese (30.00–34.99), Class 2 obese (35.00– 39.99), and Class 3 obese (&gt; 40.00).</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Patients who underwent BiTLIF had the highest median radiation exposure (113 mGy, SD 9.44), whereas microdiscectomy required minimal exposure (12.62 mGy, SD 2.75 mGy). There was a significant correlation between radiation emission and BMI of the patients during all MISS procedures (p &lt; 0.05). The median radiation exposure was substantially greater with larger patients (p ≤ 0.001). In the analyses within the procedure groups, radiation exposure was found to be significantly high in patients who were severely obese (Class 2 and Class 3 obesity). The radiation emission was lower during the surgeries performed in 2013 than during those performed in 2010 especially in obese patients; however, this observation was not statistically significant.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Body habitus of the patients has a substantial impact on radiation emission during MISS. Severe obesity (BMI ≥ 35) is associated with a significantly greater risk of radiation exposure compared with other weight categories. Surgical experience seems to be associated with lower radiation emission especially in cases in which patients have a higher BMI; however, further studies should be performed to examine this effect.</jats:p></jats:sec>

The Effect of Body Mass Index on Fluoroscopic Time and Radiation Dose During Sacroiliac Joint Injections

“…The present data echo the finding that larger body habitus correlates with increased radiation dose [7,9,12,13,18], particularly because fluoroscopic time is equivalent between groups. This increase in dose poses a potential risk to both the patient and the medical staff.…”

“…In addition to its well‐documented deleterious health effects [2‐6], elevated body mass index (BMI) has been shown to increase radiation exposure in fluoroscopic procedures because of increased needle manipulation time, increased positioning time, and increased emission from the C‐arm to pass through increased tissue mass to the detector [7‐13]. Smuck et al [8] demonstrated increased procedure and fluoroscopy times for overweight patients during fluoroscopic‐guided spine procedures.…”

A Systematic Review of Complications Following Minimally Invasive Spine Surgery Including Transforaminal Lumbar Interbody Fusion

“…Of the 31 articles, 26 articles specified the complications following MI-TLIF (Table 1). There were five articles that met inclusion criteria but did not report complications [35][36][37][38][39]. The most common complication cited after MI-TLIF surgery was radiculitis, with a range between rates of 2.8 and 57.1%.…”

Evaluation of the new C‐arm guiding system ClearGuide® in an orthopaedic and trauma operating theatre

“…Moreover, in the present study patients body mass index (BMI) was not recorded. For future studies, the BMI should be considered for matching as an elevated BMI influences image acquisition and can increase the amount of scatter radiation …”