Radiation Exposure to the Surgeon During Open Lumbar Microdiscectomy and Minimally Invasive Microdiscectomy

Mariscalco, Michael W.; Yamashita, Takayuki; Steinmetz, Michael P.; Krishnaney, Ajit A.; Lieberman, Isador H.; Mroz, Thomas E.

doi:10.1097/brs.0b013e3181ceb976

Cited by 105 publications

(66 citation statements)

References 21 publications

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“…Radiation exposure was a potential health hazard to the operating surgeon during mTLIF with continued exposure during surgery. Minimally invasive lumbar surgery cases expose the surgeon to significantly more radiation than open lumbar surgery [25].…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive versus open transforaminal lumbar fusion: a systematic review of complications

Hu¹,

Tang²,

XianPei³

et al. 2016

International Orthopaedics (SICOT)

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Purpose The aim of this study is to compare mTLIF vs. oTLIF with regard to peri-operative complications, operative time, estimated blood loss, fluoroscopic time, and the length of hospital stay. Methods The PubMed and EMBASE databases were searched for relevant articles reporting patients undergoing TLIF, and a comparison between mTILF and oTLIF was performed. The database included patient demographic information, complications, operative time, fluoroscopic time, and the length of hospital stay. Results Fourteen studies were included in this systematic review. The total number of subjects included was 901, of which 455 underwent mTLIF (50 %) and 446 underwent oTLIF (50 %). The operating time for the mTLIF was ranged from 116 to 390 minutes, compared with 102 to 365 minutes for oTLIF, the operating time tended to be longer in the mTLIF group than the oTLIF group. The estimated blood loss was lower in the mTLIF group, ranging from 51 to 578 ml in mTLIF and 225 to 961 ml in oTLIF, respectively. Length of hospital stay was short for the mTLIF with a 2.3 to 10.6 days hospitalization compared to 2.9 to 14.6 days for oTLIF. However the fluoroscopic time was consistently higher in the mTLIF group with a 49 to 106 seconds of fluoroscopy compared to 16.4 to 44 seconds for oTLIF. The complications divided into technical complications and infection complications. The main technical and infection complications included dural tears, screw malposition, and wound infection. Systemic complications included pneumonia, urinary tract infection, and DVT. The numbers of patients with complication was 54 out of 455 (11.87 %) in the mTLIF, and 64 out of 446 (14.35 %) in the oTLIF. Conclusion The review shows mTLIF offers several potential advantages in reducing blood loss and the length of hospital stay, especially lowering the complication rates for patients compared with oTLIF. However, it required much more operative time and radiation exposure. Class I evidence and highquality randomized controlled trials are needed for further study. Keywords Complications . Minimally invasive spine surgery . Transforaminal lumbar interbody fusionTransforaminal lumbar interboby fusion (TLIF) has been widely performed for degenerative lumbar disease since Harms [1] popularized the procedure. It provides circumferential spinal fusion, restores disc height, and maintains the normal lordosis of the lumbar spine. Due to these advantages and good fusion rates in 95 % [2-6], TLIF has been proven as a safe and effective technique in the past three decades. However, extensive paravertebral muscle stripping and retraction during the procedure to obtain an adequate surgical field causes significant soft tissue injury. This iatrogenic

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Section: Discussionmentioning

confidence: 99%

Minimally invasive versus open transforaminal lumbar fusion: a systematic review of complications

Hu¹,

Tang²,

XianPei³

et al. 2016

International Orthopaedics (SICOT)

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“…However, the increasing popularity of MISS in recent years has also raised the concern of a higher risk of radiation exposure to all personnel in the operating room. 1,6,12,19 There are 2 types of harmful effects of radiation exposure: acute, or deterministic, effects and late, or stochastic, effects. Acute or deterministic effects (erythema, epilation, and dermal necrosis) occur due to a high dose of radiation exposure, whereas stochastic effects (carcinogenesis and hereditary disorders) can occur at radiation doses lower than the dose limits of the various organs of our body.…”

Section: Discussionmentioning

confidence: 99%

“…9,22 According to the National Council on Radiation Protection and Measurement, yearly occupational exposure limit for the body is 5 roentgen equivalent in man (rem), 50 rem for the extremity, and 15 rem for the eyes. 16 Mariscalco et al 12 compared radiation exposure between open versus MISS microdiscectomy and observed significantly more radiation exposure in MISS than in open procedures. However, microdiscectomy performed using MISS techniques still appears to be safe, because the number of cases required to exceed the occupational exposure limit for the whole body and extremity is substantially large (1623 and 11,235 cases, respectively).…”

Section: Discussionmentioning

confidence: 99%

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

Kukreja¹,

Haydel²,

Nanda³

et al. 2015

SPI

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OBJECT 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. METHODS 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] < 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 (> 40.00). RESULTS 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 < 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. CONCLUSIONS 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.

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“…Mariscalco et al [18] assessed radiation exposure in a prospective study comparing open and less invasive microdiscectomies. The surgeon wore dosimeters outside the lead protection in less invasive microdiscectomies and without lead protection on open microdiscectomies.…”

Section: Search Strategy and Criteriamentioning

confidence: 99%

Does Less Invasive Spine Surgery Result in Increased Radiation Exposure? A Systematic Review

Khan

2014

Clinical Orthopaedics &Amp; Related Research

104

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Radiation Exposure to the Surgeon During Open Lumbar Microdiscectomy and Minimally Invasive Microdiscectomy

Cited by 105 publications

References 21 publications

Minimally invasive versus open transforaminal lumbar fusion: a systematic review of complications

Minimally invasive versus open transforaminal lumbar fusion: a systematic review of complications

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

Does Less Invasive Spine Surgery Result in Increased Radiation Exposure? A Systematic Review

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