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Radiation dose reduction in thoracic and lumbar spine instrumentation using navigation based on an intraoperative cone beam CT imaging system: a prospective randomized clinical trial

European Spine Journal volume 26, pages 2818–2827 (2017)Cite this article

Abstract

Purpose

Spine surgery still remains a challenge for every spine surgeon, aware of the potential serious outcomes of misplaced instrumentation. Though many studies have highlighted that using intraoperative cone beam CT imaging and navigation systems provides higher accuracy than conventional freehand methods for placement of pedicle screws in spine surgery, few studies are concerned about how to reduce radiation exposure for patients with the use of such technology. One of the main focuses of this study is based on the ALARA principle (as low as reasonably achievable).

Method

A prospective randomized trial was conducted in the hybrid operating room between December 2015 and December 2016, including 50 patients operated on for posterior instrumented thoracic and/or lumbar spinal fusion. Patients were randomized to intraoperative 3D acquisition high-dose (standard dose) or low-dose protocol, and a total of 216 pedicle screws were analyzed in terms of screw position. Two different methods were used to measure ionizing radiation: the total skin dose (derived from the dose–area product) and the radiation dose evaluated by thermoluminescent dosimeters on the surgical field.

Results

According to Gertzbein and Heary classifications, low-dose protocol provided a significant higher accuracy of pedicle screw placement than the high-dose protocol (96.1 versus 92%, respectively). Seven screws (3.2%), all implanted with the high-dose protocol, needed to be revised intraoperatively. The use of low-dose acquisition protocols reduced patient exposure by a factor of five.

Conclusion

This study emphasizes the paramount importance of using low-dose protocols for intraoperative cone beam CT imaging coupled with the navigation system, as it at least does not affect the accuracy of pedicle screw placement and irradiates drastically less.

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Authors and Affiliations

  1. Service d’orthopédie et de traumatologie de l’appareil locomoteur, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, B-1200, Brussels, Belgium

    Nathalie Pireau, Xavier Banse & Nadia Irda

  2. Computer assisted and Robotic Surgery (CARS), Institut de recherche expérimentale et clinique, Université catholique de Louvain, Avenue Mounier 53, B-1200, Brussels, Belgium

    Virginie Cordemans

  3. Department of Medical Physics, Vinçotte Controlatom, Olieslagerslaan 35, B-1800, Vilvoorde, Belgium

    Sébastien Lichtherte

  4. Service d’orthopédie et de traumatologie de l’appareil locomoteur, Cliniques Saint-Pierre, Avenue Reine Fabiola 9, 1340, Ottignies, Belgium

    Ludovic Kaminski

  5. Hippokrateslaan 10/19, 1932, Sint-Stevens Woluwe, Belgium

    Ludovic Kaminski

Authors
  1. Nathalie Pireau
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  2. Virginie Cordemans
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  3. Xavier Banse
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  4. Nadia Irda
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  6. Ludovic Kaminski
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Correspondence to Ludovic Kaminski.

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Pireau, N., Cordemans, V., Banse, X. et al. Radiation dose reduction in thoracic and lumbar spine instrumentation using navigation based on an intraoperative cone beam CT imaging system: a prospective randomized clinical trial. Eur Spine J 26, 2818–2827 (2017). https://doi.org/10.1007/s00586-017-5229-x

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  • DOI: https://doi.org/10.1007/s00586-017-5229-x

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