Related Experiment Video
Updated: Jun 9, 2026
Novel Mini-open Transforaminal Lumbar Interbody Fusion
Published on: June 6, 2025
Radiation exposure to the surgeon during open lumbar microdiscectomy and minimally invasive microdiscectomy: a
Michael W Mariscalco1, Takayuki Yamashita, Michael P Steinmetz
1Spine Institute, Cleveland Clinic, Cleveland, OH, USA.
Study Design:
This is a prospective in vivo study comparing radiation exposure to the surgeon during 10 minimally invasive lumbar microdiscectomy cases with 10 traditional open discectomy cases as a control.
Objective:
Radiation exposure to the eye, chest, and hand of the operating surgeon during minimally invasive surgery (MIS) and open lumbar microdiscectomy were measured. The Occupational Exposure Guidelines were used to calculate the allowable number of cases per year from the mean values at each of the 3 sites.
Summary Of Background Data:
Fluoroscopy is a source of ionizing radiation and as such, is a potential health hazard with continued exposure during surgery. Presently, radiation exposure to the surgeon during MIS lumbar microdiscectomy is unknown.
Methods:
Radiation exposure to the surgeon (millirads [mR]) per case was measured by digital dosimeters placed at the level of the thyroid/eye, chest, and dominant forearm. Other data collected included operative side and level, side of the surgeon, side of the x-ray source, total fluoroscopy time, and energy output.
Results:
The average radiation exposure to the surgeon during open cases was thyroid/eye 0.16 ± 0.22 mR, chest 0.21 ± 0.23 mR, and hand 0.20 ± 0.14 mR. During minimally invasive cases exposure to the thyroid/eye was 1.72 ± 1.52 mR, the chest was 3.08 ± 2.93 mR, and the hand was 4.45 ± 3.75 mR. The difference between thyroid/ eye, chest, and hand exposure during open and minimally invasive cases was statistically significant (P = 0.010, P = 0.013, and P = 0.006, respectively). Surgeons standing in an adjacent substerile room during open cases were exposed to 0.2 mR per case.
Conclusion:
MIS lumbar microdiscectomy cases expose the surgeon to significantly more radiation than open microdiscectomy. One would need to perform 1623 MIS microdiscectomies to exceed the exposure limit for whole-body radiation, 8720 cases for the lens of the eye, and 11,235 cases for the hand. Standing in a substerile room during x-ray localization in open cases is not fully protective.
Insights
Minimally invasive lumbar microdiscectomy significantly increases surgeon radiation exposure compared to open procedures. Further research is needed to establish safe practice guidelines for radiation safety in spine surgery.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Radiological Safety
Background:
- Fluoroscopy use in surgery presents a radiation hazard.
- Surgeon radiation exposure during minimally invasive lumbar microdiscectomy is not well-documented.
Purpose of the Study:
- To quantify and compare surgeon radiation exposure during minimally invasive surgery (MIS) versus open lumbar microdiscectomy.
- To evaluate radiation exposure at the eye, chest, and hand.
Main Methods:
- Prospective in vivo study comparing 10 MIS lumbar microdiscectomy cases with 10 open discectomy cases.
- Digital dosimeters measured radiation exposure (mR) at the thyroid/eye, chest, and dominant forearm.
- Fluoroscopy time and energy output were recorded.
Main Results:
- MIS cases showed significantly higher radiation exposure: thyroid/eye (1.72 ± 1.52 mR), chest (3.08 ± 2.93 mR), and hand (4.45 ± 3.75 mR) compared to open cases.
- Open cases had lower exposure: thyroid/eye (0.16 ± 0.22 mR), chest (0.21 ± 0.23 mR), and hand (0.20 ± 0.14 mR).
- Surgeons in an adjacent room during open cases still received 0.2 mR exposure.
Conclusions:
- Minimally invasive lumbar microdiscectomy results in significantly greater surgeon radiation exposure than open procedures.
- Calculations indicate a high number of MIS cases are required to reach occupational exposure limits.
- Even adjacent rooms offer limited protection during open procedure fluoroscopy.
