Cargando…

Free-Hand MIS TLIF without 3D Navigation—How to Achieve Low Radiation Exposure for Both Surgeon and Patient

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 fluo...

Descripción completa

Detalles Bibliográficos
Autores principales: Doria-Medina, Roberto, Hubbe, Ulrich, Scholz, Christoph, Sircar, Ronen, Brönner, Johannes, Hoedlmoser, Herbert, Klingler, Jan-Helge
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10419541/
https://www.ncbi.nlm.nih.gov/pubmed/37568527
http://dx.doi.org/10.3390/jcm12155125
_version_ 1785088548930584576
author Doria-Medina, Roberto
Hubbe, Ulrich
Scholz, Christoph
Sircar, Ronen
Brönner, Johannes
Hoedlmoser, Herbert
Klingler, Jan-Helge
author_facet Doria-Medina, Roberto
Hubbe, Ulrich
Scholz, Christoph
Sircar, Ronen
Brönner, Johannes
Hoedlmoser, Herbert
Klingler, Jan-Helge
author_sort Doria-Medina, Roberto
collection PubMed
description 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.
format Online
Article
Text
id pubmed-10419541
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-104195412023-08-12 Free-Hand MIS TLIF without 3D Navigation—How to Achieve Low Radiation Exposure for Both Surgeon and Patient Doria-Medina, Roberto Hubbe, Ulrich Scholz, Christoph Sircar, Ronen Brönner, Johannes Hoedlmoser, Herbert Klingler, Jan-Helge J Clin Med Article 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. MDPI 2023-08-04 /pmc/articles/PMC10419541/ /pubmed/37568527 http://dx.doi.org/10.3390/jcm12155125 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Doria-Medina, Roberto
Hubbe, Ulrich
Scholz, Christoph
Sircar, Ronen
Brönner, Johannes
Hoedlmoser, Herbert
Klingler, Jan-Helge
Free-Hand MIS TLIF without 3D Navigation—How to Achieve Low Radiation Exposure for Both Surgeon and Patient
title Free-Hand MIS TLIF without 3D Navigation—How to Achieve Low Radiation Exposure for Both Surgeon and Patient
title_full Free-Hand MIS TLIF without 3D Navigation—How to Achieve Low Radiation Exposure for Both Surgeon and Patient
title_fullStr Free-Hand MIS TLIF without 3D Navigation—How to Achieve Low Radiation Exposure for Both Surgeon and Patient
title_full_unstemmed Free-Hand MIS TLIF without 3D Navigation—How to Achieve Low Radiation Exposure for Both Surgeon and Patient
title_short Free-Hand MIS TLIF without 3D Navigation—How to Achieve Low Radiation Exposure for Both Surgeon and Patient
title_sort free-hand mis tlif without 3d navigation—how to achieve low radiation exposure for both surgeon and patient
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10419541/
https://www.ncbi.nlm.nih.gov/pubmed/37568527
http://dx.doi.org/10.3390/jcm12155125
work_keys_str_mv AT doriamedinaroberto freehandmistlifwithout3dnavigationhowtoachievelowradiationexposureforbothsurgeonandpatient
AT hubbeulrich freehandmistlifwithout3dnavigationhowtoachievelowradiationexposureforbothsurgeonandpatient
AT scholzchristoph freehandmistlifwithout3dnavigationhowtoachievelowradiationexposureforbothsurgeonandpatient
AT sircarronen freehandmistlifwithout3dnavigationhowtoachievelowradiationexposureforbothsurgeonandpatient
AT bronnerjohannes freehandmistlifwithout3dnavigationhowtoachievelowradiationexposureforbothsurgeonandpatient
AT hoedlmoserherbert freehandmistlifwithout3dnavigationhowtoachievelowradiationexposureforbothsurgeonandpatient
AT klinglerjanhelge freehandmistlifwithout3dnavigationhowtoachievelowradiationexposureforbothsurgeonandpatient