Intra-operative fluoroscopy exposure in endoscopic lumbar discectomies

Spinal endoscopic procedures require the use of fluoroscopy to guide the placement of the instrumentation. This results in exposure to ionizing radiation of both medical staff and patients. This study aimed to evaluate the radiation doses during endoscopic lumbar discectomies in our institution.

From July 2023 to February 2024, 54 patients with lumbar spine disc herniations were operated on by a single surgeon; operations included using a mobile C-arm to perform interlaminar endoscopic lumbar discectomy (IELD, n = 18) or transforaminal endoscopic lumbar discectomy (TELD, n = 36). For each procedure, the following variables were analyzed: patient-related (age, gender, weight, and body mass index) and radiation-related data (fluoroscopy time [FT], tube voltage [kVp], kerma-area product [KAP], and cumulative air-kerma [CAK]).

Patients' age, procedural duration, number of cine acquisitions, and all radiation-related metrics (FT, KAP, CAK) demonstrated a significant difference between the two groups examined. Skin doses in both groups were well below the safe threshold. The mean age of the total sample was 52.27 years. The mean kVp was 103.44 for IELD group and 95.69 for TELD group. The mean KAP was 8.18 dGycm² for IELD group and 29.09 dGycm² for TELD group. CAK was 4.72 mGy for IELD group and 15.87 mGy for TELD group. The mean FT was 18.72 s for IELD group and 54.94 s for TELD group.

Intra-operative fluoroscopy results in a relatively low radiation dose during endoscopic discectomy procedures. We found comparable radiation dose data between both endoscopic techniques (IELD and TELD). However, transforaminal techniques require more FT and it is a more demanding procedure.