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Longitudinal Pilot Analysis of Radiation Exposure During the Course of Growing Rod Treatment for Early-Onset Scoliosis

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Abstract

Study Design

Retrospective consecutive case series.

Objectives

To estimate the amount of ionizing radiation (IR) exposure in growing rod (GR) surgery for early-onset scoliosis.

Summary of Background Data

There is substantial evidence of the health hazards attributed to IR exposure. However, no studies have estimated the amount of IR exposure in GR surgery.

Materials and Methods

A consecutive single-center series of GR patients were retrospectively reviewed. Of 28 total patients, 24 had a minimum 2-year follow-up and complete records available for analysis. All spine-related IR imaging studies excluding intraoperative fluoroscopy were tabulated and IR estimated based on historical controls in millisieverts (mSv).

Results

Initial x-ray evaluation for scoliosis was performed at a mean age of 4.0 years (range 5 birth to 9.7). Mean radiographic period was 8.5 years (range 5 2.2 to 19.4). There was a statistically significant inverse correlation between patient age at time of initial IR and total mean IR (p <.05). Total IR was 3.4 times greater than that of estimated background radiation (2.4 mSv per year). Mean IR before index surgery and during the first postoperative year were 22.41 mSv and 10.78 mSv, respectively. Annual IR after the first postoperative year averaged 7.02 mSv (range 5 2.25 to 13.45). Patients who underwent at least one revision surgery experienced significantly higher IR than nonrevision patients (79.95 vs. 46.58 mSv; <.05). Overall, 89% of total IR was attributed to x-rays and 11% from computed tomography.

Conclusions

Compared to the general public, GR patients had 3.4 times more IR than the estimated background radiation for the same duration of time. Younger patients and those requiring revision surgery had significantly higher IR doses. This study underscores the importance of recognizing the amount of IR used in the management of GR patients and its potential long-term risks.

Level of Evidence

III.

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Author information

Authors and Affiliations

  1. San Diego Center for Spinal Disorders, 4130 La Jolla Village Dr # 300, San Diego, CA, 92037, USA

    Gregory M. Mundis Jr MD, Jeff B. Pawelek BS, Edward K. Nomoto MD, Michael W. Hennessy MD & Behrooz A. Akbarnia MD

  2. Rady Children’s Hospital San Diego, 3020 Children’s Way, San Diego, CA, 92123, USA

    Burt Yaszay MD

Authors
  1. Gregory M. Mundis Jr MD
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  2. Jeff B. Pawelek BS
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  3. Edward K. Nomoto MD
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  4. Michael W. Hennessy MD
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  5. Burt Yaszay MD
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  6. Behrooz A. Akbarnia MD
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Corresponding author

Correspondence to Gregory M. Mundis Jr MD.

Additional information

Institutional Review Board: This study was approved by the IRB at Rady Children’s Hospital San Diego before the study’s initiation.

Author disclosures: GMM (has board membership in SOLAS; receives consultancy fees from Nuvasive, K2M, Medicrea, and Misonix; royalties from Nuvasive, K2M; and payment for development of educational presentations from Nuvasive); JBP (none); EKN (none); MWH (is currently employed with Texas Spine Consultants); BY (receives consultancy fees from Depuy Synthes, Nuvasive, Globus, K2M; is currently employed with Rady Children’s Hospital; has grants/grants pending from Depuy Synthes and POSNA; receives payment for lectures, including service on bureaus, from Depuy Synthes and K2M; has patents [planned, pending, or issued] through K2M; and receives royalties from K2M and Orthopediatrics); BAA (receives consultancy fees from Ellipse Technologies, KSpine, and K2M; has grants/grants pending from Ellipse Technologies; receives royalties from K2M, DePuy Spine, and Nuvasive; and has stock/stock options in Ellipse Technologies, KSpine, and Nuvasive).

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Mundis, G.M., Pawelek, J.B., Nomoto, E.K. et al. Longitudinal Pilot Analysis of Radiation Exposure During the Course of Growing Rod Treatment for Early-Onset Scoliosis. Spine Deform 4, 55–58 (2016). https://doi.org/10.1016/j.jspd.2015.06.004

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  • DOI: https://doi.org/10.1016/j.jspd.2015.06.004

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