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Intraoperative radiation exposure in spinal scoliosis surgery for pediatric patients using the O-arm® imaging system

  • Original Article • SPINE - IMAGING
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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

The O-arm® navigation system allows intraoperative CT imaging that can facilitate highly accurate instrumentation surgery, but radiation exposure is higher than with X-ray radiography. This is a particular concern in pediatric surgery. The purpose of this study is to examine intraoperative radiation exposure in pediatric spinal scoliosis surgery using O-arm.

Methods

The subjects were 38 consecutive patients (mean age 12.9 years, range 10–17) with scoliosis who underwent spinal surgery with posterior instrumentation using O-arm. The mean number of fused vertebral levels was 11.0 (6–15). O-arm was performed before and after screw insertion, using an original protocol for the cervical, thoracic, and lumbar spine doses.

Results

The average scanning range was 6.9 (5–9) intervertebral levels per scan, with 2–7 scans per patient (mean 4.0 scans). Using O-arm, the dose per scan was 92.5 (44–130) mGy, and the mean total dose was 401 (170–826) mGy. This dose was 80.2% of the mean preoperative CT dose of 460 (231–736) mGy (P = 0.11). The total exposure dose and number of scans using intraoperative O-arm correlated strongly and significantly with the number of fused levels; however, there was no correlation with the patient’s height.

Conclusions

As the fused range became wider, several scans were required for O-arm, and the total radiation exposure became roughly the same as that in preoperative CT. Use of O-arm in our original protocol can contribute to reduction in radiation exposure.

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Acknowledgement

We are grateful to Mr. Masataka Achiwa and Mr. Naruto Sugimoto for helping with data collection.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya, Aichi, 466-8550, Japan

    Kazuyoshi Kobayashi, Kei Ando, Kenyu Ito, Mikito Tsushima, Masayoshi Morozumi, Satoshi Tanaka, Masaaki Machino, Kyotaro Ota, Naoki Ishiguro & Shiro Imagama

Authors
  1. Kazuyoshi Kobayashi
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  2. Kei Ando
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  3. Kenyu Ito
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  4. Mikito Tsushima
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  5. Masayoshi Morozumi
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  6. Satoshi Tanaka
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  7. Masaaki Machino
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  8. Kyotaro Ota
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  9. Naoki Ishiguro
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  10. Shiro Imagama
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Corresponding author

Correspondence to Shiro Imagama.

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The authors have no financial conflicts of interest.

Additional information

This paper is designed and submitted acting on guideline of IRB of Nagoya Spine Group Hospital, and these patients have signed consent form for this report.

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Cite this article

Kobayashi, K., Ando, K., Ito, K. et al. Intraoperative radiation exposure in spinal scoliosis surgery for pediatric patients using the O-arm® imaging system. Eur J Orthop Surg Traumatol 28, 579–583 (2018). https://doi.org/10.1007/s00590-018-2130-1

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  • DOI: https://doi.org/10.1007/s00590-018-2130-1

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