Does Less Invasive Spine Surgery Result in Increased Radiation Exposure? A Systematic Review
Radiation exposure to patients and spine surgeons during spine surgery is expected. The risks of radiation exposure include thyroid cancer, cataracts, and lymphoma. Although imaging techniques facilitate less invasive approaches and improve intraoperative accuracy, they may increase radiation exposure.
We performed a systematic review to determine whether (1) radiation exposure differs in open spine procedures compared with less invasive spine procedures; (2) radiation exposure differs in where the surgeon is positioned in relation to the C-arm; and (3) if radiation exposure differs using standard C-arm fluoroscopy or fluoroscopy with computer-assisted navigation.
A PubMed search was performed from January 1980 to July 2013 for English language articles relating to radiation exposure in spine surgery. Twenty-two relevant articles met inclusion criteria. Level of evidence was assigned on clinical studies. Traditional study quality evaluation of nonclinical studies was not applicable.
There are important risks of radiation exposure in spine surgery to both the surgeon and patient. There is increased radiation exposure in less invasive spine procedures, but the use of protective barriers decreases radiation exposure. Where the surgeon stands in relation to the image source is important. Increasing the distance between the location of the C-arm radiation source and the surgeon, and standing contralateral from the C-arm radiation source, decreases radiation exposure. The use of advanced imaging modalities such as CT or three-dimensional computer-assisted navigation can potentially decrease radiation exposure.
There is increased radiation exposure during less invasive spine surgery, which affects the surgeon, patient, and operating room personnel. Being cognizant of radiation exposure risks, the spine surgeon can potentially minimize radiation risks by optimizing variables such as the use of barriers, knowledge of position, distance from the radiation source, and use of advanced image guidance navigation-assisted technology to minimize radiation exposure. Continued research is important to study the long-term risk of radiation exposure and its relationship to cancer, which remains a major concern and needs further study as the popularity of less invasive spine surgery increases.
- 3.Bronsard N, Boli T, Challali M, de Dompsure R, Amoretti N, Padovani B, Bruneton G, Fuchs A, de Peretti F. Comparison between percutaneous and traditional fixation of lumbar spine fracture: intraoperative radiation exposure levels and outcomes. Orthop Traumatol Surg Res. 2013;99:162–168.PubMedCrossRefGoogle Scholar
- 4.Fischetti M. Exposed. Medical imaging delivers big doses of radiation. Sci Am. 2011;304:96.Google Scholar
- 6.Gebhard FT, Kraus MD, Schneider E, Liener UC, Kinzl L, Arand M. Does computer-assisted spine surgery reduce intraoperative radiation doses? Spine (Phila Pa 1976). 2006;31:2024–2027; discussion 2028.Google Scholar
- 9.Giordano BD, Grauer JN, Miller CP, Morgan TL, Rechtine GR 2nd. Radiation exposure issues in orthopaedics. J Bone Joint Surg Am. 2011;93:e69(61–10).Google Scholar
- 10.Hayashi A. Radiation exposure in the OR: is it safe? AAOS Now. 2008. Available at: http://www.aaos.org/news/aaosnow/dec08/clinical1.asp. Accessed December 1, 2013.
- 14.Kruger R, Faciszewski T. Radiation dose reduction to medical staff during vertebroplasty: a review of techniques and methods to mitigate occupational dose. Spine (Phila Pa 1976). 2003;28:1608–1613.Google Scholar
- 24.Mulconrey DS. Fluoroscopic radiation exposure in spinal surgery: in vivo evaluation for operating room personnel. J Spinal Disord Tech. 2013 Nov 7 [Epub ahead of print].Google Scholar
- 27.Recommendations of the International Commission on Radiological Protection. New York, NY, USA: International Commission on Radiological Protection; 1990;21.Google Scholar
- 28.Recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP. 2007;37:1–332.Google Scholar
- 29.Recommendations on Limits for Exposure to Ionizing Radiation. Bethesda, MD, USA: National Council on Radiation Protection and Measurements; 1987:91.Google Scholar
- 35.US Nuclear Regulatory Commission Basic References. US Nuclear Regulatory Commission. Available at: http://www.nrc.gov/reading-rm/basic-ref.html. Accessed December 1, 2013.