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Updated: Mar 28, 2026
Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion
Published on: August 6, 2019
Patient and surgeon radiation exposure during spinal instrumentation using intraoperative computed tomography-based
Daniel Mendelsohn1, Jason Strelzow1, Nicolas Dea1
1Combined Neurosurgical and Orthopedic Spine Program, Vancouver General Hospital, Departments of Orthopedics and Neurosurgery, University of British Columbia, Vancouver, Canada; Faculty of Dentistry, Department of Oral Biological and Medical Sciences, University of British Columbia, Vancouver, Canada.
Intraoperative CT navigation for spine surgery increases patient radiation exposure but significantly reduces surgeon exposure compared to traditional methods. While patient doses are acceptable, surgeons must be aware of these implications.
Area of Science:
- Spine Surgery
- Medical Imaging
- Radiation Oncology
Background:
- Intraoperative imaging for spinal anatomy includes X-ray, fluoroscopy, and CT, all emitting ionizing radiation.
- Minimizing radiation exposure for patients and surgical teams is a critical concern in spinal instrumentation procedures.
Purpose of the Study:
- To compare radiation exposure to patients and surgical teams during CT-navigated spine surgery versus conventional fluoroscopy-guided procedures.
- To evaluate the impact of intraoperative CT navigation on radiation doses and postoperative imaging requirements.
Main Methods:
- A retrospective cohort case-control study involving 73 patients undergoing CT-navigated spinal instrumentation and 73 matched controls using conventional fluoroscopy.
- Analysis of effective radiation doses to patients and surgical teams, comparing navigated and non-navigated cases.
- Literature review to establish historical radiation exposure benchmarks for fluoroscopic-guided spinal instrumentation.
Main Results:
- CT-navigated surgery resulted in higher patient radiation exposure (average 5.69 mSv) compared to literature values for non-navigated procedures.
- Radiation doses varied by spinal level and case complexity, with thoracic/lumbar and deformity/degenerative cases showing higher emissions.
- Despite increased patient dose, radiation to the surgical team inside the operating room was significantly lower with navigation (2.50 times less).
Conclusions:
- Intraoperative CT navigation enhances spine instrumentation accuracy, offering acceptable patient radiation exposure and reduced surgical team exposure.
- Surgeons must consider the dual implications of increased patient and decreased surgical team radiation exposure when employing CT navigation.
- Navigation did not alter the need for postoperative imaging investigations.
