Related Experiment Video
Updated: May 1, 2026
Novel Mini-open Transforaminal Lumbar Interbody Fusion
Published on: June 6, 2025
Surgeons' exposure to radiation in single- and multi-level minimally invasive transforaminal lumbar interbody fusion;
Haruki Funao1, Ken Ishii2, Suketaka Momoshima3
1Department of Orthopaedic Surgery, Nerima General Hospital, Tokyo, Japan; Society for Minimally invasive spine Stabilization (Clinical research group).
Abstract:
Although minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has widely been developed in patients with lumbar diseases, surgeons risk exposure to fluoroscopic radiation. However, to date, there is no studies quantifying the effective dose during MIS-TLIF procedure, and the radiation dose distribution is still unclear. In this study, the surgeons' radiation doses at 5 places on the bodies were measured and the effective doses were assessed during 31 consecutive 1- to 3-level MIS-TLIF surgeries. The operating surgeon, assisting surgeon, and radiological technologist wore thermoluminescent dosimeter on the unshielded thyroid, chest, genitals, right middle finger, and on the chest beneath a lead apron. The doses at the lens and the effective doses were also calculated. Mean fluoroscopy times were 38.7, 53.1, and 58.5 seconds for 1, 2, or 3 fusion levels, respectively. The operating surgeon's mean exposures at the lens, thyroid, chest, genitals, finger, and the chest beneath the shield, respectively, were 0.07, 0.07, 0.09, 0.14, 0.32, and 0.05 mSv in 1-level MIS-TLIF; 0.07, 0.08, 0.09, 0.18, 0.34, and 0.05 mSv in 2-level; 0.08, 0.09, 0.14, 0.15, 0.36, and 0.06 mSv in 3-level; and 0.07, 0.08, 0.10, 0.15, 0.33, and 0.05 mSv in all cases. Mean dose at the operating surgeon's right finger was significantly higher than other measurements parts (P<0.001). The operating surgeon's effective doses (0.06, 0.06, and 0.07 mSv for 1, 2, and 3 fusion levels) were low, and didn't differ significantly from those of the assisting surgeon or radiological technologist. Revision MIS-TLIF was not associated with higher surgeons' radiation doses compared to primary MIS-TLIF. There were significantly higher surgeons' radiation doses in over-weight than in normal-weight patients. The surgeons' radiation exposure during MIS-TLIF was within the safe level by the International Commission on Radiological Protection's guidelines. The accumulated radiation exposure, especially to surgeon's hands, should be carefully monitored.
Insights
Surgeons
Area of Science:
- Neurosurgery and Orthopedic Surgery
- Radiological Protection
- Medical Physics
Background:
- Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is a common procedure for lumbar diseases.
- Surgeons performing MIS-TLIF are exposed to fluoroscopic radiation.
- Quantifying radiation doses and understanding dose distribution in MIS-TLIF is crucial for surgeon safety.
Purpose of the Study:
- To quantify the effective radiation dose for surgeons during MIS-TLIF procedures.
- To assess the radiation dose distribution at various body parts of the surgical team.
- To compare radiation doses across different fusion levels and patient weights.
Main Methods:
- Thirty-one consecutive MIS-TLIF surgeries (1-3 levels) were analyzed.
- Thermoluminescent dosimeters were used to measure radiation doses on the unshielded thyroid, chest, genitals, and right middle finger of the operating surgeon, assisting surgeon, and radiological technologist.
- Effective doses and lens doses were calculated.
Main Results:
- Mean fluoroscopy times increased with the number of fusion levels.
- The operating surgeon's mean radiation dose was highest at the right finger.
- Effective doses for the operating surgeon were low and within international safety guidelines, with no significant difference compared to assisting staff.
- Higher radiation doses were observed in overweight patients.
- Revision MIS-TLIF did not result in higher surgeon radiation doses.
Conclusions:
- Surgeon radiation exposure during MIS-TLIF is generally within safe limits.
- Radiation doses to the hands, particularly the fingers, are significantly higher and warrant careful monitoring.
- Patient weight is a factor influencing surgeon radiation exposure.
