Kyphoplasty: Traditional imaging compared with computer-guided intervention—time to rethink technique?

Study design: Equivalence trial (IRB not required for cadaveric studies). Objective: To compare computer-guided and fluoroscopic kyphoplasty. Factors of interest were radiation exposure, position of cannula within pedicles and procedure time. Methods: Kyphoplasty was performed on two cadavers. Computer-navigated, cross-sectional images from a cone-beam CT were used for one and fluoroscopic imaging for the other. In each, T6–9 and T11–L2 vertebrae were selected. For both imaging methods, anteroposterior and lateral x-rays were taken. Radiation exposure for both procedures was measured by four dosimeters. Procedure time, radiation to surgeon and cadaver, and position of cannula placement within pedicles were recorded. The surgeon wore one under the lead gown, another on the lead gown at shoulder level, and a third as a ring on the dominant hand. A dosimeter was also placed on the cadaver. Results: The radiation from the cone-beam, computer-guided imaging system was 0.0 mrem to the surgeon and 0.52 rads to the cadaver. Using fluoroscopic imaging, surgeon's and cadaver's exposure was 5 mrem and 0.047 rads, respectively. Procedure times were similar and neither device resulted in cannula malposition. Conclusions: Cone-beam CT appears as accurate as the fluoroscopy; radiation exposure to the surgeon is eliminated, and radiation levels to the patient are acceptable.