The Fluoroscopy Paradox: Radiation Exposure, Dose Optimization, and Occupational Risk in Full-Endoscopic and Biportal...

Area of Science:

• Spine Surgery
• Medical Imaging
• Radiation Safety

Background:

• Endoscopic spine surgery (ESS) provides advantages such as smaller incisions and quicker recovery.
• The narrow working corridor in ESS increases reliance on intraoperative fluoroscopy, raising radiation exposure concerns for patients and surgeons.

Purpose of the Study:

• To provide a practical resource on radiation exposure in ESS.
• To review radiation doses, influencing factors, and optimization strategies for endoscopic spine procedures.

Main Methods:

• Narrative review synthesizing existing literature on ESS radiation doses.
• Comparison of radiation exposure between ESS, minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), and open spine surgery.
• Evaluation of dose-optimization techniques, from basic measures to advanced technologies.

Main Results:

• Simple, cost-effective measures like collimation and pulsed fluoroscopy significantly reduce radiation doses.
• Advanced technologies, including navigation and robotics, offer additional benefits, especially for endoscopic interbody fusion.
• Basic radiation reduction techniques are crucial and complement advanced technologies.

Conclusions:

• Endoscopic spine surgery can maintain a favorable safety profile with routine dosimetry and adherence to As-Low-As-Reasonably-Achievable (ALARA) principles.
• A combination of fundamental and advanced radiation reduction strategies is key to managing exposure effectively.
• Further research is needed due to the retrospective and heterogeneous nature of current evidence.