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Radiation Exposure in Minimally Invasive Cervical Spine Surgery: A Systematic Review.

Dong Hun Kim¹, Jung-Woo Hur², Jae Taek Hong²

¹Department of Neurosurgery, Bucheon St. Mary's Hospital, The Catholic University of Korea, Seoul 14647, Republic of Korea.

Medicina (Kaunas, Lithuania)

|May 27, 2026

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Minimally invasive cervical spine surgery radiation exposure is within safety limits, but more research is needed. Standalone implants and navigation reduce radiation doses for patients and staff during these procedures.

Area of Science:

Neurosurgery
Radiology
Orthopedic Surgery

Background:

Minimally invasive cervical spine surgery (MIS-CSS) utilizes fluoroscopy, raising radiation exposure concerns for patients and staff.
Cervical MIS radiation exposure lacks systematic review despite unique anatomical risks (thyroid, eye lens).

Purpose of the Study:

Quantify intraoperative radiation exposure during MIS-CSS.
Evaluate radiation dose reduction strategies in MIS-CSS.

Main Methods:

Systematic literature search (PubMed, Scopus, Google Scholar) following PRISMA 2020 guidelines.
Included studies reporting quantitative radiation data for adult MIS-CSS (≥10 patients).
Assessed study quality using MINORS and JBI checklists.

Keywords:

cervical spine dose reduction fluoroscopy minimally invasive surgery occupational radiation radiation exposure radiation safety

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Main Results:

Seven studies (380 patients) analyzed: ACDF, posterior cervical laminoforaminotomy, CT-navigated instrumentation.
ACDF patient effective doses: 0.015–1.3 mSv; thyroid doses: 0.194–0.290 mGy.
Standalone ACDF reduced patient dose by 36-58%; navigation-assisted posterior cervical foraminotomy showed negligible staff exposure. Surgeon exposure in cervical discectomy was ~50% of lumbar discectomy.

Conclusions:

Radiation doses in MIS-CSS appear within occupational limits, but evidence is insufficient for definitive thresholds.
Standalone implants and intraoperative navigation are effective dose-reduction strategies.
Standardized prospective research is essential for cervical-specific radiation safety benchmarks.