Radiation Exposure to the Surgeon and the Patient During Posterior Lumbar Spinal Instrumentation: A Prospective Randomized Comparison of Navigated vs Non-Navigated Free-Hand Techniques

Publié le 06 octobre 2014 • Catégorie(s) : Rayonnements •

Auteur    Jimmy Villard
Auteur    Yu-Mi Ryang
Auteur    Andreas K Demetriades
Auteur    Andreas Reinke
Auteur    Michael Behr
Auteur    Alexander Preuss
Auteur    Bernhard Meyer
Auteur    Florian Ringel
Publication    Spine
ISSN    1528-1159
Date    Apr 11, 2014
Résumé    Study Design. A prospective randomized study.Objective. To compare occupational radiation exposure to the surgeon, as well as the patient, during posterior lumbar spine instrumentation in 10 navigated cases (N) versus 11 cases using the free-hand technique (nonN).Summary of Background Data. The use of navigation increases the accuracy of posterior lumbar instrumentation. A further speculated benefit of navigation is the reduction of radiation exposure of the surgeon. However, this has so far not been evaluated in such comparative manner.Methods. Radiation exposure to the surgeon was measured by digital dosimeters placed at the level of the eye, chest, and dominant forearm. Radiation exposure was measured from the time of positioning of the patient to the end of the procedure both for navigated (intraoperative 3D fluoroscopy-based) and non-navigated (2D fluoroscopy-guided) free hand posterior lumbar spine instrumentations. A 3D fluoroscopy scan was routinely performed at the end of the procedure for all patients.Results. Patients in the two study groups were distributed evenly with respect to in the two groups in terms of sex, age, BMI and the number of operated levels. The accumulated radiation dose was significantly higher in the non-navigated group; up to 9.96 times. The radiation dose for the patient was higher with the free hand technique, 1884.8 cGycm (nonN) vs 887 cGycm (N), without reaching a statistically significant level.Conclusions. Radiation exposure to the surgeon during pedicle screw placement with the free-hand technique is up to 9.96 times greater than with the use of navigation. In this latter group, the only radiation exposure comes from the pre-op level control and positioning of the 3D C-arm before 3D fluoroscopy acquisition. Furthermore, neuronavigation also reduces the cumulative dose for the patient.