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

Background and Objectives: Minimally invasive cervical spine surgery (MIS-CSS) relies heavily on intraoperative fluoroscopic imaging, raising concerns about radiation exposure to patients and surgical staff. Unlike lumbar MIS, cervical-specific radiation exposure has not been systematically reviewed, despite distinct anatomical considerations, including proximity to the thyroid gland and lens of the eye. This review aims to quantify intraoperative radiation exposure during MIS cervical spine procedures and evaluate available dose-reduction strategies. Materials and Methods: A systematic literature search was conducted across PubMed/MEDLINE, Scopus, and Google Scholar in April 2026 following PRISMA 2020 guidelines. Studies reporting original quantitative radiation data during minimally invasive cervical spine procedures in adult patients (≥10 patients) were included. Quality was assessed using the MINORS tool and the JBI checklist. Results: Seven studies encompassing 380 patients were included. Procedures comprised ACDF (four studies), minimally invasive posterior cervical laminoforaminotomy (two studies), and CT-navigated cervical instrumentation (one study). Patient effective doses during ACDF ranged from 0.015 to 1.3 mSv, with thyroid doses of 0.194-0.290 mGy. Standalone ACDF reduced patient dose by 36-58% compared to plated ACDF (p < 0.001). Navigation-assisted posterior cervical foraminotomy achieved a median fluoroscopy time of 10 s with negligible staff exposure. Surgeon per-procedure exposure during cervical discectomy (chest 0.122 µSv, lens 3.1 µSv, hands 7.1 µSv) was approximately half that of lumbar discectomy. Conclusions: Radiation doses during individual MIS cervical procedures appear to be within occupational safety limits, though the current evidence is insufficient to establish definitive dose thresholds. Standalone implant designs and intraoperative navigation represent effective, complementary dose-reduction strategies. Standardized prospective research is needed to establish cervical-specific radiation safety benchmarks.