Navigation Versus Fluoroscopy in Multilevel MIS Pedicle Screw Insertion: Separate Analysis of Exposure to Radiation of the Surgeon and of the Patients.

STUDY

DESIGN

This study was a retrospective radiographic analysis of consecutive patients.

OBJECTIVES

To analyze exposure to radiation of the surgeon and-separately-of patients in minimally invasive surgery (MIS) of multilevel posterior stabilization by percutaneous pedicle screw insertion guided by navigation (PIN) versus percutaneous pedicle screw insertion guided by fluoroscopy (PIF).

SUMMARY OF BACKGROUND DATA: Spine surgeons are exposed to a 12-fold higher dose of radiation than other nonspinal musculoskeletal surgeons and PIF in MIS leads to a 2-fold higher dose of radiation than in open surgery. PIN might reduce the dose of radiation for the surgeon and the patient, especially in multilevel MIS surgery. To the best of our knowledge, there are only rare data of short-segment fusions that do not focus on exposure to radiation of surgeons.

METHODS

After power analysis, we included 205 consecutive screws (22 patients). We monitored dose of radiation (recorded separately for patient and surgeon), accuracy of screw placement, time of operation, and approach-related complications.

RESULTS

In PIN, only 58.7% of dose area product (cGy×cm) per screw of PIF was determined for patients (P<0.01). The surgeon was only exposed to 19.9% of radiation per screw in PIN compared with dosage in PIF (P<0.01). Four of 205 screws (2.0%) were classified as being incorrectly positioned: 2 of 87 screws (2.3%) in PIF and 2 of 118 screws (1.7%) in PIN (P>0.05). We did not observe any wound infections.

CONCLUSIONS

PIN in MIS is a safe procedure and does, compared with PIF, lead to significant reduction of radiation dose for patients and-even more-for spine surgeons.