Radiation Exposure to Surgeon in Minimally Invasive Transforaminal Lumbar Interbody Fusion With Novel Spinal Locators

Fan, Guoxin; Fu, Qiuping; Gu, Guangfei; Zhang, Hailong; Guan, Xiaofei; Zhang, Lei; Gu, Xia; He, Shisheng

doi:10.1097/bsd.0000000000000210

Cited by 23 publications

(21 citation statements)

References 30 publications

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“…15 Shielding prevention such as lead aprons or thyroid gland shield was regarded as the most efficient method. 11 Keeping away from the tube like 3 feet way or more was considered as the second important method to reduce the radiation. 16 Optimizing the C-arm fluoroscopy setting means using automatic pulse mode as much as possible and keeping the tube under the operating table.…”

Section: Discussionmentioning

confidence: 99%

“…10 Therefore, we designed a surface locator to identify the surgical target and applied this self-made device in clinical practice. 11–13 However, preoperative location with our self-made surface locator might not be sufficient to reduce the fluoroscopy during PTED. In order to optimize the lumbar location system, we also designed a puncture-assisted device to optimize the puncture trajectory of PTED.…”

Section: Introductionmentioning

confidence: 99%

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Significant Improvement of Puncture Accuracy and Fluoroscopy Reduction in Percutaneous Transforaminal Endoscopic Discectomy With Novel Lumbar Location System

et al. 2015

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Prospective nonrandomized control study.The study aimed to investigate the implication of the HE's Lumbar LOcation (HELLO) system in improving the puncture accuracy and reducing fluoroscopy in percutaneous transforaminal endoscopic discectomy (PTED).Percutaneous transforaminal endoscopic discectomy is one of the most popular minimally invasive spine surgeries that heavily depend on repeated fluoroscopy. Increased fluoroscopy will induce higher radiation exposure to surgeons and patients. Accurate puncture in PTED can be achieved by accurate preoperative location and definite trajectory.The HELLO system mainly consists of self-made surface locator and puncture-assisted device. The surface locator was used to identify the exact puncture target and the puncture-assisted device was used to optimize the puncture trajectory. Patients who had single L4/5 or L5/S1 lumbar intervertebral disc herniation and underwent PTED were included the study. Patients receiving the HELLO system were assigned in Group A, and those taking conventional method were assigned in Group B. Study primary endpoint was puncture times and fluoroscopic time, and the secondary endpoint was location time and operation time.A total of 62 patients who received PTED were included in this study. The average age was 45.35 ± 8.70 years in Group A and 46.61 ± 7.84 years in Group B (P = 0.552). There were no significant differences in gender, body mass index, conservative time, and surgical segment between the 2 groups (P > 0.05). The puncture time(s) were 1.19 ± 0.48 in Group A and 6.03 ± 1.87 in Group B (P < 0.001). The fluoroscopic times were 14.03 ± 2.54 in Group A and 25.19 ± 4.28 in Group B (P < 0.001). The preoperative location time was 4.67 ± 1.41 minutes in Group A and 6.98 ± 0.94 minutes in Group B (P < 0.001). The operation time was 79.42 ± 10.15 minutes in Group A and 89.65 ± 14.06 minutes in Group B (P = 0.002). The hospital stay was 2.77 ± 0.95 days in Group A and 2.87 ± 1.02 days in Group B (P = 0.702). There were no significant differences in the complication rate between the 2 groups (P = 0.386).The highlight of HELLO system is accurate preoperative location and definite trajectory. This preliminary report indicated that the HELLO system significantly improves the puncture accuracy of PTED and reduces the fluoroscopic time, preoperative location time, as well as operation time. (ChiCTR-ICR-15006730)

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Significant Improvement of Puncture Accuracy and Fluoroscopy Reduction in Percutaneous Transforaminal Endoscopic Discectomy With Novel Lumbar Location System

et al. 2015

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“…Our mean fluoroscopy time of 29.3 seconds compares favorably with other studies that report means times ranging from 38.7 seconds to 3.7 minutes for one-level operations. 35–38 Recently, a low-dose radiation protocol has been described that combines direct exposure and visualization of pedicle landmarks and avoidance of biplanar fluoroscopy (as in our technique) with pulsed low-dose fluoroscopy (that produces lower resolution images) to push mean fluoroscopy time to 10.4 seconds. 39 …”

Section: Discussionmentioning

confidence: 99%

Modified Mini-open Transforaminal Lumbar Interbody Fusion

Pakzaban¹

2016

Spine

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Study Design.Retrospective case series.Objective.To describe a modified technique for mini-open transforaminal lumbar interbody fusion (TLIF) that improves visualization for decompression, fusion, and freehand pedicle screw insertion. Accuracy of freehand pedicle screw placement with this technique was assessed.Summary of Background Data.Mini-open TLIF is a minimally invasive technique that allows limited visualization of the bone and neural anatomy via an expandable tubular retractor inserted through the Wiltse plane. No significant modification that of this technique has been described in detail.Methods.In this study, 92 consecutive patients underwent one-level modified mini-open TLIF (MOTLIF). MOTLIF modifications consisted of (i) transmuscular dissection through the multifidus muscle rather than intermuscular dissection in the Wiltse plane; (ii) microsurgical detachment of multifidus from the facet rather than muscle dilation; (iii) en bloc total facetectomy (unilateral or bilateral, as needed for decompression); (iv) facet autograft used for interbody fusion; and (v) solid pedicle screws placed bilaterally by a freehand technique under direct vision.Results.The mean age was 53 years. Mean follow-up was 35 months (minimum 2 yrs). By 6 months, mean Visual Analog Scale for back and leg pain had improved from 51 to 19 and from 58 to 17, respectively, and mean Oswestry Disability Index (ODI) improved from 53 to 16. These improvements persisted at 2 years. Solid fusion, defined by computed tomography at 1 year, was achieved in 88.1%, whereas satisfactory fusion was achieved in 95.2% of patients. Pedicle screws were accurately placed in 335 of 336 imaged pedicles (pedicle breach grades: 91.1% grade 1; 8.6% grade 2; and 0.3% grade 3). Mean fluoroscopy time was 29.3 seconds.Conclusion.MOTLIF is a safe and effective minimally invasive technique with a high fusion rate. It allows accurate pedicle screw placement by a freehand technique. By eliminating bi-planar fluoroscopy, it helps reduce radiation exposure. This is the largest published report of mini-open TLIF to date.Level of Evidence: 4

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“…Firstly, it would be very beneficial to use our HE's lumbar location (HELLO) system to guide the puncture. This system has been shown to reduce the puncture time and minimize radiation exposure (Fan et al, 2015a;2015b;2015c). Lastly, it has been widely accepted that foraminoplasty may be conducted during transforaminal PELD.…”

Section: Discussionmentioning

confidence: 99%

Learning curves of percutaneous endoscopic lumbar discectomy in transforaminal approach at the L4/5 and L5/S1 levels: a comparative study

Fan

et al. 2016

J. Zhejiang Univ. Sci. B

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Abstract:Objectives: This study aimed to compare the learning curves of percutaneous endoscopic lumbar discectomy (PELD) in a transforaminal approach at the L4/5 and L5/S1 levels. Methods: We retrospectively reviewed the first 60 cases at the L4/5 level (Group I) and the first 60 cases at the L5/S1 level (Group II) of PELD performed by one spine surgeon. The patients were divided into subgroups A, B, and C (Group I: A cases 1-20, B cases 21-40, C cases 41-60; Group II: A cases 1-20, B cases 21-40, C cases 41-60). Operation time was thoroughly analyzed. Results: Compared with the L4/5 level, the learning curve of transforaminal PELD at the L5/S1 level was flatter. The mean operation times of Groups IA, IB, and IC were (88.75±17.02), (67.75±6.16), and (64.85±7.82) min, respectively. There was a significant difference between Groups A and B (P<0.05), but no significant difference between Groups B and C (P=0.20). The mean operation times of Groups IIA, IIB, and IIC were (117.25±13.62), (109.50±11.20), and (92.15±11.94) min, respectively. There was no significant difference between Groups A and B (P=0.06), but there was a significant difference between Groups B and C (P<0.05). There were 6 cases of postoperative dysesthesia (POD) in Group I and 2 cases in Group IIA (P=0.27). There were 2 cases of residual disc in Group I, and 4 cases in Group II (P=0.67). There were 3 cases of recurrence in Group I, and 2 cases in Group II (P>0.05). Conclusions: Compared with the L5/S1 level, the learning curve of PELD in a transforaminal approach at the L4/5 level was steeper, suggesting that the L4/5 level might be easier to master after short-term professional training.

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Radiation Exposure to Surgeon in Minimally Invasive Transforaminal Lumbar Interbody Fusion With Novel Spinal Locators

Abstract: The study indicated that radiation exposure to the surgeon would be effectively reduced in MIS-TLIF using our surface locator and intradermal locator, and it could be another practical choice for radiation-minimizing strategy.

Cited by 23 publications

References 30 publications

Significant Improvement of Puncture Accuracy and Fluoroscopy Reduction in Percutaneous Transforaminal Endoscopic Discectomy With Novel Lumbar Location System

Significant Improvement of Puncture Accuracy and Fluoroscopy Reduction in Percutaneous Transforaminal Endoscopic Discectomy With Novel Lumbar Location System

Modified Mini-open Transforaminal Lumbar Interbody Fusion

Learning curves of percutaneous endoscopic lumbar discectomy in transforaminal approach at the L4/5 and L5/S1 levels: a comparative study

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