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Internally Randomized Control Trial of Radiation Exposure Using Ultra-low Radiation Imaging Versus Traditional C-arm Fluoroscopy for Patients Undergoing Single-level Minimally Invasive Transforaminal Lumbar Interbody Fusion.
- Source :
-
Spine [Spine (Phila Pa 1976)] 2017 Feb 15; Vol. 42 (4), pp. 217-223. - Publication Year :
- 2017
-
Abstract
- Study Design: Randomized controlled trial.<br />Objective: To compare radiation exposure between ultra-low radiation imaging (ULRI) with image enhancement and standard-dose fluoroscopy for patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).<br />Summary of Background Data: Although the benefits of MIS are lauded by many, there is a significant amount of radiation exposure to surgeon and operating room personnel. Our goal with this work was to see if by using ultra-low dose radiation settings coupled with image enhancement, this exposure could be minimized.<br />Methods: An institutional review board approved, prospective, internally randomized controlled trial was performed comparing ultra-low dose settings coupled with image enhancement software to conventional fluoroscopic imaging. In this study, each patient served as their own control, randomly assigning one side of MIS-TLIF for cannulation and K-wire placement using each imaging modality. Further, the case was also randomly divided into screw placement and cage placement/final images to allow further comparisons amongst patients. Radiation production from the C-arm fluoroscope and radiation exposure to all operating room personnel were recorded.<br />Results: Twenty-four patients were randomly assigned to undergo a single level MIS-TLIF. In no case was low radiation imaging abandoned, and no patient had a neurologic decline or required hardware repositioning. Everyone in the operating room-the physician, scrub nurse, circulator, and anesthesiologist-all benefited with 61.6% to 83.5% reduction in radiation exposure during cannulation and K-wire placement to screw insertion aided by ULRI. In every case but the anesthesiologist dose, this was statistically significant (Pā<ā0.05). This benefit required no additional time (Pā=ā0.78 for K-wire placement).<br />Conclusion: ULRI, when aided by image enhancement software, affords the ability for all parties in the operating room to substantially decrease their radiation exposure compared with standard-dose C-arm fluoroscopy without adding additional time or an increased complication rate.<br />Level of Evidence: 2.
- Subjects :
- Adult
Bone Screws
Humans
Male
Middle Aged
Minimally Invasive Surgical Procedures methods
Prospective Studies
Radiation Dosage
Surgery, Computer-Assisted methods
Fluoroscopy instrumentation
Fluoroscopy methods
Lumbar Vertebrae surgery
Lumbosacral Region surgery
Radiation Exposure adverse effects
Spinal Fusion methods
Subjects
Details
- Language :
- English
- ISSN :
- 1528-1159
- Volume :
- 42
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Spine
- Publication Type :
- Academic Journal
- Accession number :
- 28207655
- Full Text :
- https://doi.org/10.1097/BRS.0000000000001720