Radiation Exposure During Pedicle Screw Placement in Adolescent Idiopathic Scoliosis: Is Fluoroscopy Safe?

Haque, Maahir Ul; Shufflebarger, Harry L.; O’Brien, Michael F.; Macagno, Angel

doi:10.1097/01.brs.0000238675.91612.2f

Cited by 126 publications

(70 citation statements)

References 13 publications

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“…Fewer pedicle screws have been shown to result in a shorter operative time and decreased radiation if intraoperative fluoroscopy is used. 52 The minimum screw density pattern reduces the operative time (mean 145 minutes vs 177 minutes for 10-level fusion) required for screw placement. 12,22 Shorter operative time may conceivably decrease the rate of infections and other medical complications.…”

Section: Limitations Of the Medical Modelmentioning

confidence: 99%

What would be the annual cost savings if fewer screws were used in adolescent idiopathic scoliosis treatment in the US?

Larson

Polly

Ackerman

et al. 2016

SPI

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OBJECT There is substantial heterogeneity in the number of screws used per level fused in adolescent idiopathic scoliosis (AIS) surgery. Assuming equivalent clinical outcomes, the potential cost savings of using fewer pedicle screws were estimated using a medical decision model with sensitivity analysis. METHODS Descriptive analyses explored the annual costs for 5710 AIS inpatient stays using discharge data from the 2009 Kids’ Inpatient Database (Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality), which is a national all-payer inpatient database. Patients between 10 and 17 years of age were identified using the ICD-9-CM code for idiopathic scoliosis (737.30). All inpatient stays were assumed to represent 10-level fusions with pedicle screws for AIS. High screw density was defined at 1.8 screws per level fused, and the standard screw density was defined as 1.48 screws per level fused. The surgical return for screw malposition was set at $23,762. A sensitivity analysis was performed by varying the cost per screw ($600–$1000) and the rate of surgical revisions for screw malposition (0.117%–0.483% of screws; 0.8%–4.3% of patients). The reported outcomes include estimated prevented malpositioned screws (set at 5.1%), averted revision surgeries, and annual cost savings in 2009 US dollars, assuming similar clinical outcomes (rates of complications, revision) using a standard- versus high-density pattern. RESULTS The total annual costs for 5710 AIS hospital stays was $278 million ($48,900 per patient). Substituting a high for a standard screw density yields 3.2 fewer screws implanted per patient, with 932 malpositioned screws prevented and 21 to 88 revision surgeries for implant malposition averted, and a potential annual cost savings of $11 million to $20 million (4%–7% reduction in the total cost of AIS hospitalizations). CONCLUSIONS Reducing the number of screws used in scoliosis surgery could potentially decrease national AIS hospitalization costs by up to 7%, which may improve the safety and efficiency of care. However, such a screw construct must first be proven safe and effective.

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Section: Limitations Of the Medical Modelmentioning

confidence: 99%

What would be the annual cost savings if fewer screws were used in adolescent idiopathic scoliosis treatment in the US?

Larson

Polly

Ackerman

et al. 2016

SPI

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“…28,29 Fluoroscopic techniques have been reported to have relatively high false-negative rates. 30 A study by Ul Haque et al 20 on radiation exposure with all screw constructs in adolescent idiopathic scoliosis showed that a nonclassified radiation worker (i.e. the surgeon) inserting approximately 2,800 screws under fluoroscopic guidance is projected to receive 13.49 mSv of whole body ionizing radiation and 4.31 mSv of thyroid gland irradiation annually.…”

Section: Descriptores: Fluoroscopía Tornillos óSeos; Columna Vertebrmentioning

confidence: 99%

“…This technique results in the least radiation exposure to the patient and surgeon but is less accurate in placing contained pedicle screws as compared to imaging techniques. 18 A fluoroscopic technique may provide more consistent results but carries some risks associated with radiation dose, especially to young patients 19,20 and to the surgeon. 20 This manual PediGuard technique most closely matches the freehand manual technique.…”

Section: Introductionmentioning

confidence: 99%

“…18 A fluoroscopic technique may provide more consistent results but carries some risks associated with radiation dose, especially to young patients 19,20 and to the surgeon. 20 This manual PediGuard technique most closely matches the freehand manual technique. The PediGuard is a pedicle probe but provides the surgeon with additional feedback in the form of an audible tone when a breech has occurred or is about to occur.…”

Section: Introductionmentioning

confidence: 99%

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Reduction in Radiation (Fluoroscopy) While Maintaining Safe Placement of Pedicle Screws During Lumbar Spine Fusion

Chaput

George²,

Samdani

et al. 2012

Spine

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Objective: The purpose of this study is to report the results using PediGuard (electrical conductivity device) to reduce radiation exposure while drilling the pilot hole for pedicle screw placement. Method: Eighteen patients diagnosed with a degenerative lumbar spine, that required a posterior spinal fusion. Average age of the patients were 55 ± 12 years. Patients received postoperative CT scans of all screws. Scans were reviewed by an independent reviewer grading 'in' < 2 mm of breach , or 'out' > 2 mm of breach. In a randomized fashion, the surgeon created pilot holes with either his standard technique or by using the PediGuard. Fluoroscopy was used for each drilling as necessary. Once the pilot hole was created, the surgeon inserted titanium screws into the pedicle pilot holes. A total of 78 screws (39 standard probe and 39 PediGuard ) were analyzed. Results: 78 screws (39 standard probe and 39 PediGuard were analyzed. No significant difference in breach rate > 2mm by either method (p=1.000), with one screw out in each group. Fluoroscopy shots averaged 5.2 (range, 0 to 15), average decrease of 2.3 (30%) per screw in the PediGuard group vs. 7.5 (range, 2 to 17) in the standard group (p< .001). Conclusion: This trial to assess pedicle probe location within the pedicle and vertebral body showed the number of fluoroscopy shots were reduced by 30%, compared to a standard probe while maintaining a 97.5% screw placement accuracy.

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“…In spinal surgery, high doses of ionizing radiation are delivered during surgical procedures that require fluoroscopic control, such as correction of spinal deformities with third generation transpedicular screws or kyphoplasty (12,17). Therefore, radiation safety has become a major concern for spinal surgeons in recent years.…”

Section: Introductionmentioning

confidence: 99%

Fluoroscopy for transpedicular screw placement in scoliosis: to what extent can radiation exposure be reduced by the freehand technique?

Ege¹,

Bïlgïç²,

Koca³

et al. 2012

Turkish Neurosurgery

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AIm:In spinal surgery, high doses of radiation are delivered during surgical procedures that require fluoroscopic control. The aim of this study was to determine the amount of radiation delivered from the fluoroscopic unit and also the factors to reduce the amount of radiation during the surgery of adolescent idiopathic scoliosis patients. sOnuÇ: Adolasan idiopatik skolyozlu hastaların cerrahi düzeltmesinde transpediküler vidaların serbest el tekniği ile yerleştirilmesi, AP ve lateral floroskobik görüntüler ile vida pozisyonunun teyidi sırasında birden fazla segmentin görüntülenmesi, anormal pediküler anatominin olduğu segmentlerde K tellerinin klavuz olarak kullanılması ve hastanın nöromoniterizasyonu hastaya ve cerrahi takıma iletilen iyonize radyasyon miktarını azaltabilir.

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Radiation Exposure During Pedicle Screw Placement in Adolescent Idiopathic Scoliosis: Is Fluoroscopy Safe?

Abstract: The spinal surgeon's intraoperative radiation exposure may be unacceptable. Spinal surgeons should be considered classified workers and monitored accordingly. Methods to lower radiation dosage seem strongly indicated.

Cited by 126 publications

References 13 publications

What would be the annual cost savings if fewer screws were used in adolescent idiopathic scoliosis treatment in the US?

What would be the annual cost savings if fewer screws were used in adolescent idiopathic scoliosis treatment in the US?

Reduction in Radiation (Fluoroscopy) While Maintaining Safe Placement of Pedicle Screws During Lumbar Spine Fusion

Fluoroscopy for transpedicular screw placement in scoliosis: to what extent can radiation exposure be reduced by the freehand technique?

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