Radiation exposure during posterior lumbar intervertebral fusion procedures, using intraoperative CT versus conventional C-arms

Abstract

Minimal invasive posterior lumbar interbody fusion procedures can be performed with the help of imaging devices used for navigation. The main problem with the use of X-ray imaging techniques is the exposure of ionizing radiation to patients and staff. In this study, we aim to investigate the radiation exposure to patient and staff with iCT versus biplanar C- arms during MI-PLIF procedures. We determined patients' PSD and ED, and the ED incurred by staff. To evaluate the efficiency, we measured two time intervals. The present data indicate that iCT has a larger radiation area with a lower localized dose, while C-arm fluoroscopy results in a localized radiation area with a higher focal dose. The ED of the patient with iCT increased by fourfold compared with the conventional biplanar C-arms. However, the ED for the surgeon was almost 17 times lower and 6 times lower for the nurse in the iCT group. For the evaluation of the full operation length, the average difference was one hour between both groups. When solely evaluating the duration for the screw placement, the procedure performed with iCT was on average 37 minutes longer than the procedure with fluoroscopy. In conclusion, the iCT is an interesting neuronavigation device for operating personnel to reduce and possibly eliminate radiation exposure in MI-PLIF procedures. However, adjustments can be made to lower the patients dose and staff could be trained to overcome the learning curve of the Airo® iCT.