Affiliation:
1. Department of Neurosurgery, Medical Center, University of Freiburg, 79106 Freiburg, Germany
2. Mirion Technologies (AWST) GmbH, 81739 Munich, Germany
Abstract
Background: Transforaminal lumbar interbody fusion (TLIF) is one of the most frequently performed spinal fusion techniques, and this minimally invasive (MIS) approach has advantages over the traditional open approach. A drawback is the higher radiation exposure for the surgeon when conventional fluoroscopy (2D-fluoroscopy) is used. While computer-assisted navigation (CAN) reduce the surgeon’s radiation exposure, the patient’s exposure is higher. When we investigated 2D-fluoroscopically guided and 3D-navigated MIS TLIF in a randomized controlled trial, we detected low radiation doses for both the surgeon and the patient in the 2D-fluoroscopy group. Therefore, we extended the dataset, and herein, we report the radiation-sparing surgical technique of 2D-fluoroscopy-guided MIS TLIF. Methods: Monosegmental and bisegmental MIS TLIF was performed on 24 patients in adherence to advanced radiation protection principles and a radiation-sparing surgical protocol. Dedicated dosemeters recorded patient and surgeon radiation exposure. For safety assessment, pedicle screw accuracy was graded according to the Gertzbein–Robbins classification. Results: In total, 99 of 102 (97.1%) pedicle screws were correctly positioned (Gertzbein grade A/B). No breach caused neurological symptoms or necessitated revision surgery. The effective radiation dose to the surgeon was 41 ± 12 µSv per segment. Fluoroscopy time was 64 ± 34 s and 75 ± 43 radiographic images per segment were performed. Patient radiation doses at the neck, chest, and umbilical area were 65 ± 40, 123 ± 116, and 823 ± 862 µSv per segment, respectively. Conclusions: Using a dedicated radiation-sparing free-hand technique, 2D-fluoroscopy-guided MIS TLIF is successfully achievable with low radiation exposure to both the surgeon and the patient. With this technique, the maximum annual radiation exposure to the surgeon will not be exceeded, even with workday use.
Funder
The Scientific Society Freiburg
University of Freiburg
Reference39 articles.
1. A Meta-Analysis Comparing ALIF, PLIF, TLIF and LLIF;Teng;J. Clin. Neurosci.,2017
2. Percutaneous Pedicle Screw Fixation of the Lumbar Spine;Foley;Neurosurg. Focus,2001
3. Advances in Minimally Invasive Spine Surgery;Foley;Clin. Neurosurg.,2002
4. Minimally Invasive Transforaminal Lumbar Interbody Fusion (MI-TLIF): Surgical Technique, Long-Term 4-Year Prospective Outcomes, and Complications Compared with an Open TLIF Cohort;Wong;Neurosurg. Clin. N. Am.,2014
5. Funao, H., Ishii, K., Momoshima, S., Iwanami, A., Hosogane, N., Watanabe, K., Nakamura, M., Toyama, Y., and Matsumoto, M. (2014). Surgeons’ Exposure to Radiation in Single- and Multi-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion; a Prospective Study. PLoS ONE, 9.