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Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion
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Prospective Evaluation of a Low-Dose Radiation Fluoroscopy Protocol for Minimally Invasive Transforaminal Lumbar

Luis M Tumialán1,2, Justin C Clark1, Laura A Snyder1

  • 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.

Operative Neurosurgery (Hagerstown, Md.)
|March 6, 2018
PubMed
Abstract

Insights

A new low-dose radiation fluoroscopy protocol for minimally invasive surgery for transforaminal lumbar interbody fusion (MIS TLIF) significantly reduces radiation exposure and fluoroscopy time. This protocol maintains visualization and procedural safety, optimizing radiation dose and acquisition time.

Area of Science:

  • Neurosurgery
  • Orthopedic Surgery
  • Medical Imaging

Background:

  • Radiation exposure is a concern in minimally invasive surgery for transforaminal lumbar interbody fusion (MIS TLIF).
  • A low-dose radiation fluoroscopy protocol has been developed to reduce fluoroscopy times and radiation exposure.
  • Previous research indicated the potential benefits of this protocol.

Purpose of the Study:

  • To prospectively evaluate a previously reported low-dose radiation fluoroscopy protocol for MIS TLIF.
  • To assess the impact of the protocol on fluoroscopy time, radiation dose, and operative efficiency.

Main Methods:

  • Prospective evaluation of 65 consecutive patients undergoing MIS TLIF using a low-dose radiation fluoroscopy protocol.
  • Analysis of total fluoroscopy time, radiation dose, and operative times for all enrolled patients.
  • Placement of 260 pedicle screws was performed during the procedures.

Main Results:

  • The study included 65 patients (43 women, 22 men) with a mean age of 63 years.
  • Mean operative time was 178.7 minutes, mean fluoroscopic time was 10.43 seconds.
  • Mean radiation dose was 0.295 mGy × m2, with a range of 0.092-0.314 mGy × m2.

Conclusions:

  • The low-dose protocol, combining pulsed and digital spot images, reduces fluoroscopy time and radiation dose in MIS TLIF.
  • Visualization of bony anatomy, procedure safety, and efficiency were not compromised.
  • The protocol decouples fluoroscopy time from radiation dose, primarily due to digital spot imaging, emphasizing optimization of both dose and acquisition time.

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