Radiation Exposure in Percutaneous Spinal Cord Stimulation Mapping: A Preliminary Report

Abstract

Background: The utilization of spinal cord stimulation (SCS) to treat intractable pain has increased substantially in recent years. Integral to this therapy, the fluoroscope assists with requisite mapping protocols during trialing procedures to identify topographical dermatomal representations of spinal segments, and its use demands measurements of radiation exposure. However, such data is not found in the literature. Purpose: The aim of this study was to report on radiation exposure during percutaneous SCS trialing procedures. Design: An observational study. Setting: A non-university out-patient Interventional Pain Management practice in the United States. Methods: Fluoroscopy time from 110 SCS trialing procedures performed in a non-university, outpatient setting was studied retrospectively. Summary statistics were reported for all procedures collectively, as well as for lead arrangement and location. The interventional spine team carried out all procedural cases with the same mobile C-arm fluoroscopy system. Incident air kerma was evaluated by simplistic modeling. Results: Mean total fluoroscopy time was 133.4 s with a standard deviation of 84.8 s, and the mean percentage of time allocated to pulsed fluoroscopy was 31.9%. Fluoroscopy time for the most common lead arrangement/location, neural canal dual leads/low-thoracic (n=87), ranged from 28.5 s to 387.4 s. Incident air kerma was 1.8–43.7 mGy. Limitations: A preliminary report with a sample size of 110. Conclusion: Various lead placement options are available to the spinal interventionalist to treat pain with SCS. Our data set provides first steps to obtain benchmark reference estimates on fluoroscopy times and radiation exposure during SCS trialing procedures/spinal segment mapping. Fluoroscopy times for such interventions may be considerable when compared to more commonly performed pain medicine procedures; however, skin injury is improbable. Key words: Neuromodulation, radiation safety, fluoroscopy, dosimetry, dose reduction, health physics