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Robinson C, Hussain N, Abd-Elsayed AA. Methods for percutaneous discectomy. DECOMPRESSIVE TECHNIQUES 2024:27-44. [DOI: 10.1016/b978-0-323-87751-0.00013-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Chen LP, Wen BS, Xu H, Lu Z, Yan LJ, Deng H, Fu HB, Yuan HJ, Hu PP. Coaxial radiography guided puncture technique for percutaneous transforaminal endoscopic lumbar discectomy: A randomized control trial. World J Clin Cases 2023; 11:3802-3812. [PMID: 37383116 PMCID: PMC10294157 DOI: 10.12998/wjcc.v11.i16.3802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/19/2023] [Accepted: 04/19/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND The coaxial radiography-guided puncture technique (CR-PT) is a novel technique for endoscopic lumbar discectomy. As the X-ray beam and the puncturing needle are maintained in a parallel and coaxial direction, the X-ray beam can be used to guide the trajectory angle, facilitating the choice of the puncture site and providing real-time guidance. This puncture technique offers numerous advantages over the conventional anterior-posterior and lateral radiography-guided puncture technique (AP-PT), especially in cases of herniated lumbar discs with a hypertrophied transverse process or articular process, high iliac crest, and narrowed intervertebral foramen.
AIM To confirm whether CR-PT is a superior approach to percutaneous transforaminal endoscopic lumbar discectomy compared to AP-PT.
METHODS In this parallel, controlled, randomized clinical trial, herniated lumbar disc patients appointed to receive percutaneous endoscopic lumbar discectomy treatment were recruited from the Pain Management Department of the Affiliated Hospital of Xuzhou Medical University and Nantong Hospital of Traditional Chinese Medicine. Sixty-five participants were enrolled and divided into either a CR-PT group or an AP-PT group. The CR-PT group underwent CR-PT, and the AP-PT group underwent AP-PT. The number of fluoroscopies during puncturing, puncture duration (min), surgery duration (min), VAS score during puncturing, and puncture success rate were recorded.
RESULTS Sixty-five participants were included, with 31 participants in the CR-PT group and 34 in the AP-PT group. One participant in the AP-PT group dropped out due to unsuccessful puncturing. The number of fluoroscopies [median (P25, P75)] was 12 (11, 14) in the CR-PT group vs 16 (12, 23) in the AP-PT group, while the puncture duration (mean ± SD) was 20.42 ± 5.78 vs 25.06 ± 5.46, respectively. The VAS score was 3 (2, 4) in the CR-PT group vs 3 (3, 4) in the AP-PT group. Further subgroup analysis was performed, considering only the participants with L5/S1 segment herniation: 9 patients underwent CR-PT, and 9 underwent AP-PT. The number of fluoroscopies was 11.56 ± 0.88 vs 25.22 ± 5.33; the puncture duration was 13.89 ± 1.45 vs 28.89 ± 3.76; the surgery duration was 105 (99.5, 120) vs 149 (125, 157.5); and the VAS score was 2.11 ± 0.93 vs 3.89 ± 0.6, respectively. All the above outcomes demonstrated statistical significance (P < 0.05), favoring the CR-PT treatment.
CONCLUSION CR-PT is a novel and effective technique. As opposed to conventional AP-PT, this technique significantly improves puncture accuracy, shortens puncture time and operation time, and reduces pain intensity during puncturing.
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Affiliation(s)
- Li-Ping Chen
- Department of Pain Management, The Affiliated Hospital of Xuzhou Medical College, Xuzhou 221000, Jiangsu Province, China
| | - Bin-Song Wen
- Department of Pain Management, Nantong Hospital of Traditional Chinese Medicine, Nantong 226000, Jiangsu Province, China
| | - Heng Xu
- Department of Pain Management, The Affiliated Hospital of Xuzhou Medical College, Xuzhou 221000, Jiangsu Province, China
| | - Zheng Lu
- Department of Neurosurgery, Haian People's Hospital, Nantong 226001, Jiangsu Province, China
| | - Lai-Jun Yan
- Department of Pain Management, Nantong Hospital of Traditional Chinese Medicine, Nantong 226000, Jiangsu Province, China
| | - Han Deng
- Department of Pain Management, Nantong Hospital of Traditional Chinese Medicine, Nantong 226000, Jiangsu Province, China
| | - Hong-Bo Fu
- Department of Pain Management, Nantong Hospital of Traditional Chinese Medicine, Nantong 226000, Jiangsu Province, China
| | - Hong-Jie Yuan
- Department of Pain Management, Nantong Hospital of Traditional Chinese Medicine, Nantong 226000, Jiangsu Province, China
| | - Pei-Pei Hu
- Department of Pain Management, Nantong Hospital of Traditional Chinese Medicine, Nantong 226000, Jiangsu Province, China
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Ghenbot Y, Alexis M, McCloskey K, Ahmad HS, Chauhan D, Yoon JW. Endoscopic Transforaminal Diskectomy for Far Lateral Disk Herniation Using a Fluoroscopy-Based Instrument-Tracking Navigation System: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023:01787389-990000000-00707. [PMID: 37133266 DOI: 10.1227/ons.0000000000000706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 02/08/2023] [Indexed: 05/04/2023] Open
Affiliation(s)
- Yohannes Ghenbot
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maya Alexis
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kyle McCloskey
- Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Hasan S Ahmad
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daksh Chauhan
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jang W Yoon
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Marker Screw Utilization for Minimally Invasive Transforaminal Lumbar Interbody Fusion (MS-MIS TLIF): Promises and Advantages. Medicina (B Aires) 2023; 59:medicina59030585. [PMID: 36984586 PMCID: PMC10056701 DOI: 10.3390/medicina59030585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/07/2023] [Accepted: 03/10/2023] [Indexed: 03/18/2023] Open
Abstract
Background and Objective: Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS-TLIF) has been investigated and shown excellent short- and long-term outcomes. In this paper, we describe a new MIS-TLIF technique and pedicle screw insertion using a marker screw as a guidance method. Moreover, we report perioperative, postoperative, and patient-related outcomes. In addition, this paper outlines major differences in radiation exposure, cost effectiveness and accuracy of Marker Screw Minimally Invasive Transforaminal Interbody Fusion (MS-MIS TLIF) compared to other techniques. We report our technique to share our knowledge and experience with the aim of achieving a better MIS-TLIF that would help both surgeons and patients. Materials and Methods: A prospective case series was conducted between October 2018 and February 2021. Patients undergoing MS-MIS TLIF with marker screws were consecutively included. The surgery did not exceed two levels. The patients’ medical records were reviewed, and the included patients were asked to complete two outcome-questionnaires before surgery and at the six-month visit. The surgical technique is described in this paper. Results: A total of 37 patients were recruited. The mean age was 57.35 ± 12.8 years, and more than half of the patients were females. The most common indications for surgery were degenerative disc disease and spondylolisthesis, with the typical level at L4–5. The operative time was 3.02 ± 0.83 h, while the estimated blood loss was 127.7 ± 71.1 mL. The average time for ambulation and hospitalization was 1 ± 1.1 and 2.84 ± 1.4 days, respectively. The patients described significant improvement in both questionnaires. No screw-related complications or screw revisions were needed up to two years of follow-up. Conclusions: The use of marker screws for pedicle screw placement through a minimally invasive fashion is shown to be a promising technique that can overcome many drawbacks, including cost, operative time, and radiation exposure. Performing MS-MIS TLIF can achieve a 360- degree fusion compared to percutaneous MIS-TLIF.
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Gazzeri R, Tribuzi S, Galarza M, Luigi Giuseppe Leoni M, Occhigrossi F. Ultrasound-Guided percutaneous laser disc decompression (PLDD) with fluoroscopic validation for the treatment of cervical disc herniation: Technical note. PAIN MEDICINE 2022:6873750. [PMID: 36469340 DOI: 10.1093/pm/pnac188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/18/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Percutaneous laser disc decompression (PLDD) has been regarded as an effective alternative for the treatment of cervical soft disc herniations. Repeated X-Ray scanning is essential when performing this technique. DESIGN Technical note. METHODS We present a new method for the treatment of cervical disc herniation using ultrasound to guide the needle entry to the cervical disc, to avoid excess of radiation exposure during the surgical procedure. We evaluated the efficacy of this cervical approach.We retrospectively reviewed the clinical data of 14 cases who underwent a PLDD under ultrasound (US) guidance for the treatment of contained cervical disc herniation using a 1470 Nm diode laser. The lower cervical discs (C5-C6 and C6-C7) were the most affected sites, accounting for 78.6% of surgical discs.A significant NRS reduction between baseline and 1 month (p = 0.0002) and between baseline and 12 months (p = 0.0007) was observed. CONCLUSIONS Our results support the conclusion that US guided PLDD with fluoroscopic validation is a minimally invasive technique for patients affected by herniated cervical discs, but proper choice of patients is critical. This approach should not be performed except after adequate training under close supervision of surgeons experienced in this procedure and in interventional US.
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Affiliation(s)
- Roberto Gazzeri
- Pain Therapy Unit, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Susanna Tribuzi
- Pain Therapy Unit, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Marcelo Galarza
- Regional Service of Neurosurgery, "Virgen de la Arrixaca" University Hospital, Murcia, Spain
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Kolz JM, Wagner SC, Vaccaro AR, Sebastian AS. Ergonomics in Spine Surgery. Clin Spine Surg 2022; 35:333-340. [PMID: 34321393 DOI: 10.1097/bsd.0000000000001238] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/23/2021] [Indexed: 11/26/2022]
Abstract
As physician burnout and wellness become increasingly recognized as vital themes for the medical community to address, the topic of chronic work-related conditions in surgeons must be further evaluated. While improving ergonomics and occupational health have been long emphasized in the executive and business worlds, particularly in relation to company morale and productivity, information within the surgical community remains relatively scarce. Chronic peripheral nerve compression syndromes, hand osteoarthritis, cervicalgia and back pain, as well as other repetitive musculoskeletal ailments affect many spinal surgeons. The use of ergonomic training programs, an operating microscope or exoscope, powered instruments for pedicle screw placement, pneumatic Kerrison punches and ultrasonic osteotomes, as well as utilizing multiple surgeons or microbreaks for larger cases comprise several methods by which spinal surgeons can potentially improve workspace health. As such, it is worthwhile exploring these areas to potentially improve operating room ergonomics and overall surgeon longevity.
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Affiliation(s)
- Joshua M Kolz
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Scott C Wagner
- Walter Reed National Military Medical Center, Bethesda, MD
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Fried TB, Schroeder GD, Anderson DG, Donnally CJ. Minimally Invasive Surgery (MIS) Versus Traditional Open Approach: Transforaminal Interbody Lumbar Fusion. Clin Spine Surg 2022; 35:59-62. [PMID: 33496467 DOI: 10.1097/bsd.0000000000001125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/07/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Tristan B Fried
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
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Van Nortwick SS, Leonard DA, Finlay AK, Chou L, Valone LC. Methods for Reducing Intraoperative Breast Radiation Exposure of Orthopaedic Surgeons. J Bone Joint Surg Am 2021; 103:1646-1651. [PMID: 34255759 DOI: 10.2106/jbjs.20.02024] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Standard lead aprons and vests do not adequately shield the most common breast cancer site, the upper outer quadrant (UOQ), from intraoperative radiation. The purpose of the present study was to determine if lead sleeves, wings, and/or axillary supplements decreased intraoperative radiation exposure of the UOQ of the breast. METHODS An anthropomorphic torso phantom (simulating the female surgeon) was placed adjacent to a standard operating room table. Dosimeters were placed bilaterally over the UOQ of the breast. Scatter radiation dose equivalent rates (mrem/hr) were measured during continuous fluoroscopy of a pelvic phantom (simulating the patient). Five protection configurations (no lead; lead vest; and vest with sleeves, wings, and axillary supplements), 2 surgeon positions (facing the table and perpendicular to the table), and 2 C-arm positions (anteroposterior and cross-table lateral projection) were tested. The t test was utilized with a Bonferroni correction for multiple t tests. RESULTS Lead sleeves and axillary supplements decreased intraoperative radiation exposure to the UOQ of the breast when compared with a well-fitted standard lead vest alone (p < 0.01) across all surgeon and C-arm positions. The addition of wings decreased radiation exposure to a lesser extent than sleeves or axillary supplements, and the difference when compared with the lead vest alone did not reach significance (p = 0.29). Breast radiation exposure in the C-arm cross-table lateral projection was highest across all testing. CONCLUSIONS The UOQ of the breast is not adequately protected by standard lead vests alone or vests with the addition of wings. Axillary supplements and sleeves improved protection of the breast. CLINICAL RELEVANCE Modifications of lead protective vests may improve intraoperative breast radiation protection.
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Affiliation(s)
- Sara S Van Nortwick
- Department of Orthopaedic Surgery and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Dana A Leonard
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California
| | - Andrea K Finlay
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California
| | - Loretta Chou
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California
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Tanaka M, Sonawane S, Sharma S, Fujiwara Y, Uotani K, Yamauchi T, Arataki S, Ikuma H. C-arm free reduction for thoracolumbar fracture: A technical note. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Almalki M, Alashban Y, Shubayr N. A 5-YEAR RETROSPECTIVE ANALYSIS OF IONIZING RADIATION DOSE TO HYBRID OPERATING ROOM PERSONNEL IN SAUDI ARABIA. RADIATION PROTECTION DOSIMETRY 2021; 195:36-40. [PMID: 34313304 DOI: 10.1093/rpd/ncab110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/02/2021] [Accepted: 07/01/2021] [Indexed: 06/13/2023]
Abstract
The annual average effective dose (ED) for operating room personnel (ORP) in Saudi Arabia was estimated from the period of 2015-2019 using thermoluminescent dosemeters. A retrospective analysis was conducted on annual EDs for 7530 ORP working across 52 hospitals. These workers were only exposed to radiation in the operating room. The annual average ED over the period of 5 years was found to be 0.59 mSv with no incidence of a dose above the annual dose limit of 20 mSv. The maximum annual ED reported was 15 mSv for an operating room worker in 2019. More than 88% of the workers received an annual ED of <1 mSv. The study concluded that the work environment in hybrid operating rooms across Saudi Arabia is safe. However, it is always recommended that workers take every protective measure when dealing with ionization radiation.
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Affiliation(s)
- Musaed Almalki
- Radiation Protection Program, Ministry of Health, Riyadh 12211, Saudi Arabia
| | - Yazeed Alashban
- Department of Radiological Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Nasser Shubayr
- Department of Diagnostic Radiography Technology, College of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia
- Medical Research Center, Jazan University, Jazan 45142, Saudi Arabia
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Alvarez-Breckenridge C, Muir M, Rhines LD, Tatsui CE. The Use of Skin Staples as Fiducial Markers to Confirm Intraoperative Spinal Navigation Registration and Accuracy. Oper Neurosurg (Hagerstown) 2021; 21:E193-E198. [PMID: 34038952 DOI: 10.1093/ons/opab132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/14/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND With the advent of intraoperative computed tomography (CT) for image guidance, numerous examples of accurate navigation being applied to cranial and spinal pathology have come to light. For spinal disorders, the utilization of image guidance for the placement of percutaneous spinal instrumentation, complex osteotomies, and minimally invasive approaches are frequently utilized in trauma, degenerative, and oncological pathologies. The use of intraoperative CT for navigation, however, requires a low target registration error that must be verified throughout the procedure to confirm the accuracy of image guidance. OBJECTIVE To present the use of skin staples as a sterile, economical fiducial marker for minimally invasive spinal procedures requiring intraoperative CT navigation. METHODS Staples are applied to the skin prior to obtaining the registration CT scan and maintained throughout the remainder of the surgery to facilitate confirmation of image guidance accuracy. RESULTS This low-cost, simple, sterile approach provides surface landmarks that allow reliable verification of navigation accuracy during percutaneous spinal procedures using intraoperative CT scan image guidance. CONCLUSION The utilization of staples as a fiducial marker represents an economical and easily adaptable technique for ensuring accuracy of image guidance with intraoperative CT navigation.
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Affiliation(s)
| | - Matthew Muir
- Division of Surgery, Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Laurence D Rhines
- Division of Surgery, Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Claudio E Tatsui
- Division of Surgery, Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Hamouda F, Wang TY, Gabr M, Mehta VA, Bwensa AM, Foster N, Than KD, Goodwin RC, Abd-El-Barr MM. A Prospective Comparison of the Effects of Instrument Tracking on Time and Radiation During Minimally Invasive Lumbar Interbody Fusion. World Neurosurg 2021; 152:e101-e111. [PMID: 34033952 DOI: 10.1016/j.wneu.2021.05.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Minimally invasive surgical techniques have resulted in improved patient outcomes. One drawback has been the increased reliance on fluoroscopy and subsequent exposure to ionizing radiation. We have previously shown the efficacy of a novel instrument tracking system in cadaveric and preliminary clinical studies for commonplace orthopedic and spine procedures. In the present study, we examined the radiation and operative time using a novel instrument tracking system compared with standard C-arm fluoroscopy for patients undergoing minimally invasive lumbar fusion. METHODS The radiation emitted, number of radiographs taken, and time required to complete 2 tasks were recorded between the instrument tracking systems and conventional C-arm fluoroscopy. The studied tasks included placement of the initial dilator through Kambin's triangle during percutaneous lumbar interbody fusion and placement of pedicle screws during both percutaneous lumbar interbody fusion and minimally invasive transforaminal lumbar interbody fusion with or without instrument tracking. RESULTS A total of 23 patients were included in the analysis encompassing 31 total levels. For the task of placing the initial dilator into Kambin's triangle, an average of 4.21 minutes (2.4 vs. 6.6 minutes; P = 0.002), 15 fluoroscopic images (5.4 vs. 20.5; P = 0.002), and 8.14 mGy (3.3 vs. 11.4; P = 0.011) were saved by instrument tracking. For pedicle screw insertion, an average of 5.69 minutes (3.97 vs. 9.67; P < 0.001), 14 radiographs (6.53 vs. 20.62; P < 0.001), and 7.89 mGy (2.98 vs. 10.87 mGy; P < 0.001) were saved per screw insertion. CONCLUSIONS Instrument tracking, when used for minimally invasive lumbar fusion, leads to significant reductions in radiation and operative time compared with conventional fluoroscopy.
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Affiliation(s)
| | - Timothy Y Wang
- Division of Spine, Department of Neurological Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Mostafa Gabr
- Division of Spine, Department of Neurological Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Vikram A Mehta
- Division of Spine, Department of Neurological Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Alexia M Bwensa
- Division of Spine, Department of Neurological Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Norah Foster
- Division of Spine, Department of Neurological Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Khoi D Than
- Division of Spine, Department of Neurological Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Rory C Goodwin
- Division of Spine, Department of Neurological Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Muhammad M Abd-El-Barr
- Division of Spine, Department of Neurological Surgery, Duke University Medical Center, Durham, North Carolina, USA.
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Application of Mixed Reality Using Optical See-Through Head-Mounted Displays in Transforaminal Percutaneous Endoscopic Lumbar Discectomy. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9717184. [PMID: 33644234 PMCID: PMC7902133 DOI: 10.1155/2021/9717184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 01/17/2021] [Accepted: 01/30/2021] [Indexed: 02/01/2023]
Abstract
Purpose Mixed reality (MixR) technology merges the real and virtual worlds to produce new environments and visualizations; it is being tested for numerous minimally invasive surgical procedures. This study is aimed at evaluating the use of MixR technology using optical see-through head-mounted displays (OST-HMDs) during transforaminal percutaneous endoscopic discectomy (TPED). Methods Forty-four patients treated with MixR-assisted TPED through OST-HMDs were compared with matched patients treated with conventional TPED (n = 43). In the MixR-assisted TPED group, MixR technology was used to navigate the four procedures of marking, needle insertion, foraminoplasty, and positioning of the working sheath. The clinical outcomes were evaluated based on the numerical rating scale (NRS) scores and Oswestry Disability Index (ODI) on preoperative and postoperative day 1 and at the last follow-up examination. The procedural times, radiation exposure, and eye fatigue were also recorded. All patients were followed up for at least 6 months. Results The NRS scores and ODI were significantly improved in both groups at the last follow-up visit compared with the preoperative values (P < 0.05); these values were not statistically different between the groups. The operation time and radiation exposure during marking, needle insertion, and total procedure significantly decreased in the MixR-assisted TPED group compared to those in the conventional TPED group (P < 0.05). Unfortunately, the incidence of eye fatigue increased owing to the use of OST-HMDs in the MixR-assisted TPED group. Conclusion This study shows the utility of MixR technology for image guidance in conventional TPED. Radiation exposure is decreased, and this technology serves as a valuable tool during the TPED procedure; however, the assistance of conventional fluoroscopy is still required.
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Kienzler JC, Heidecke V, Assaker R, Fandino J, Barth M. Intraoperative findings, complications, and short-term results after lumbar microdiscectomy with or without implantation of annular closure device. Acta Neurochir (Wien) 2021; 163:545-559. [PMID: 33070235 DOI: 10.1007/s00701-020-04612-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 10/06/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Standard microscopic lumbar discectomy (MLD) is a short operation with minimal blood loss, and a low rate of peri- and intraoperative complications. The objective of this study was to evaluate intraoperative findings, complications, and early postoperative neurological outcome (< 105 days) in patients undergoing MLD with or without implantation of an annular closure device (ACD). METHODS This study is based on data analysis of a post-marketing, prospective, multicenter RCT in Europe including patients undergoing standard MLD with or without implantation of an ACD (Barricaid®, Intrinsic Therapeutics, Inc., Woburn, MA). Enrollment of 554 patients in 21 centers in Europe (Germany, Switzerland, Austria, Belgium, The Netherlands, and France) started in 2010 and was completed in October 2014, with 276 patients randomized to the ACD group and 278 to the control group. RESULTS Mean operation time was 70 min in the ACD group and 52 min in the control group (p < 0.0001). Intraoperative fluoroscopy time was 24 s in the ACD group and 7 s in the control group (p < 0.0001). Average blood loss was 94.2 ml in the ACD group and 64.7 ml in the control group (p = 0.0001). Serious device- or procedure-related adverse events occurred in 3.7% (10/272) of the ACD group and 7.9% (22/278) of the control group. Dural injuries occurred in 13 (4.8%) patients in the ACD group and 7 (2.5%) in the control group. There was one device-related nerve root injury resulting in a nerve root amputation. Surgical complications included 3 hematomas in the ACD group and 4 in the control group; 3 infections occurred in both groups. Device migrations were documented in 3 patients in the ACD group. Patients in the ACD group (n = 7, 2.6%) underwent fewer reoperations compared with that in the control group (n = 16, 5.8%, OR = 2.3 (0.9-5.7)). Mean VAS leg pain at 3 months was 11.9 in the ACD and 15.1 in the control group, respectively. CONCLUSION Short-term outcome after MLD with or without implantation of ACD was similar in both groups. Patients included in the ACD group underwent fewer reoperations in the first 3 months after surgery. Nevertheless, longer operation time, higher amount of blood loss, and risk of nerve root lesion during device implantation should be considered additional risks in patients undergoing ACD implantation after MLD.
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Affiliation(s)
- Jenny C Kienzler
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Volkmar Heidecke
- Department of Neurosurgery, Klinikum Augsburg, Augsburg, Germany
| | - Richard Assaker
- Department of Neurosurgery, Centre Hospitalier Régional Universitaire of Lille, Lille, France
| | - Javier Fandino
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.
| | - Martin Barth
- Department of Neurosurgery, Klinikum Frankfurt, Frankfurt, Germany
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Jenkins NW, Parrish JM, Sheha ED, Singh K. Intraoperative risks of radiation exposure for the surgeon and patient. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:84. [PMID: 33553377 PMCID: PMC7859810 DOI: 10.21037/atm-20-1052] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Intraoperative radiological imaging serves an essential role in many spine surgery procedures. It is critical that patients, staff and physicians have an adequate understanding of the risks and benefits associated with radiation exposure for all involved. In this review, we briefly introduce the current trends associated with intraoperative radiological imaging. With the increased utilization of minimally invasive spine surgery (MIS) techniques, the benefits of intraoperative imaging have become even more important. Less surgical exposure, however, often equates to an increased requirement for intraoperative imaging. Understanding the conventions for radiation measurement, radiological fundamental concepts, along with deterministic or stochastic effects gives a framework for conceptualizing how radiation exposure relates to the risk of various sequela. Additionally, we describe the various options surgeons have for intraoperative imaging modalities including those based on conventional fluoroscopy, computer tomography, and magnetic resonance imaging. We also describe different ways to prevent unnecessary radiation exposure including dose reduction, better education, and use of personal protective equipment (PPE). Finally, we conclude with a reflection on the progress that has been made to limit intraoperative radiation exposure and the promise of future technology and policy.
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Affiliation(s)
- Nathaniel W Jenkins
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - James M Parrish
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Evan D Sheha
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Wang TY, Hamouda F, Mehta VA, Sankey EW, Yarbrough C, Lark R, Abd-El-Barr MM. Effect of Instrument Navigation on C-arm Radiation and Time during Spinal Procedures: A Clinical Evaluation. Int J Spine Surg 2020; 14:375-381. [PMID: 32699760 DOI: 10.14444/7049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction As minimally invasive spine surgery gains popularity, a focused effort must be made to reduce intraoperative radiation exposure to levels as low as reasonably achievable. Here, we demonstrate the clinical efficacy of a novel technology to aid in instrument navigation that aims to reduce intraoperative radiation exposure, number of fluoroscopic images, and time required to perform the most radiation intensive portions of a multitude of spinal procedures. Methods An internally randomized controlled study was performed over a 1-month period in order to clinically evaluate the effect of the C-arm assisted instrument tracking system, TrackX, on surgeon workflow, time, and radiation emitted. Three surgeons performed multiple spinal procedures on a total of 10 study patients and an additional 3 control patients. The surgeries encompassed minimally invasive spinal techniques and spanned extreme lateral interbody fusion, oblique lumbar interbody fusion, transforaminal lumbar interbody fusion along with percutaneous iliac screw placement, hardware removal, and kyphoplasty. The tasks studied included skin marking, first dilator insertion, localization for hardware placement and hardware removal. Results Overall radiation reduction was 83% (P < .0001). Overall reduction in x-rays taken was 78% (P < .0001). Overall time reduction was 81% (P = .0003). Statistical significance held for each surgeon studied and for nearly every procedure type. In these 10 study procedures, over 2 hours of overall operating room time was saved, all while requiring negligible set up time and no system calibration or supplementary x-rays to be taken. There were no adverse outcomes for any study patient, and there was no case where TrackX was not able to successfully complete a given portion of a procedure. Conclusions TrackX instrument navigation is a clinically efficacious and accurate instrument tracking modality. This is the first instrument navigational technology that reduces radiation exposure and images required to complete a procedure while decreasing operative time. TrackX thus allows increased surgical efficiency while increasing operative efficiency and improving intraoperative safety. Level of Evidence 2.
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Affiliation(s)
- Timothy Y Wang
- Duke University Medical Center, Department of Neurological Surgery, Durham, North Carolina
| | | | - Vikram A Mehta
- Duke University Medical Center, Department of Neurological Surgery, Durham, North Carolina
| | - Eric W Sankey
- Duke University Medical Center, Department of Neurological Surgery, Durham, North Carolina
| | - Chester Yarbrough
- Duke University Medical Center, Department of Neurological Surgery, Durham, North Carolina
| | - Robert Lark
- Duke University Medical Center, Department of Neurological Surgery, Durham, North Carolina
| | - Muhammad M Abd-El-Barr
- Duke University Medical Center, Department of Neurological Surgery, Durham, North Carolina
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17
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Overview of Minimally Invasive Spine Surgery. World Neurosurg 2020; 142:43-56. [PMID: 32544619 DOI: 10.1016/j.wneu.2020.06.043] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 12/21/2022]
Abstract
Minimally invasive spine surgery (MISS) has continued to evolve over the past few decades, with significant advancements in technology and technical skills. From endonasal cervical approaches to extreme lateral lumbar interbody fusions, MISS has showcased its usefulness across all practice areas of the spine, with unique points of access to avoid pertinent neurovascular structures. Adult spine deformity has also recognized the importance of minimally invasive techniques in its ability to limit complications and to provide adequate sagittal alignment correction and improvements in patients' functional status. Although MISS has continued to make significant progress clinically, consideration must also be given to its economic impact and the learning curve surgeons experience in adding these procedures to their armamentarium. This review examines current innovations in MISS, as well as the economic impact and future directions of the field.
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18
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Merter A, Karaeminogullari O, Shibayama M. Comparison of Radiation Exposure Among 3 Different Endoscopic Diskectomy Techniques for Lumbar Disk Herniation. World Neurosurg 2020; 139:e572-e579. [PMID: 32330613 DOI: 10.1016/j.wneu.2020.04.079] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lumbar disk herniation can be successfully treated by lumbar endoscopic spinal procedures. However, one of the most important disadvantages of the endoscopic methods used is radiation exposure. There are multiple endoscopic spinal procedures and this study aims to compare unilateral biportal endoscopic diskectomy (UBED), percutaneous endoscopic lumbar diskectomy (PELD), and microendoscopic diskectomy (MED) methods in terms of radiation exposure. METHODS A total of 75 people were included in this prospective and multicenter study. The demographic characteristics, operating times (minutes), levels of surgery, lumbar disk herniation types, radiation exposures (dose area product [DAP]), and fluoroscopy times (seconds) of the groups were compared. RESULTS Mean DAP values were 1.39 Gy·cm2 in the UBED group, 2.46 Gy·cm2 in the PELD group, and 1.01 Gy·cm2 in the MED group. The UBED group had no statistically significant difference with the MED and PELD groups in terms of DAP (P = 0.281 and P = 0.058, respectively), whereas the PELD group had statistically significantly higher DAP values than the MED group (P = 0.016). The maximum mean duration of fluoroscopy usage time was 34.9 seconds in the PELD group, 19.3 seconds in the UBED group, and 4.6 seconds in the MED group. The differences between the groups were significant (P ≤ 0.001). CONCLUSIONS The more the level of invasiveness is reduced in spinal surgery, the greater the exposure to radiation. In this study, the groups are listed as PELD > UBED > MED according to the duration and level of radiation exposure.
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Affiliation(s)
- Abdullah Merter
- Department of Orthopedics, Spine Section, School of Medicine, Ibn-i Sina Hospital, Ankara University, Ankara, Turkey.
| | - Oguz Karaeminogullari
- Department of Orthopedics, Spine Section, Bayindir Sogutozu Hospital, Ankara, Turkey
| | - Motohide Shibayama
- Department of Orthopedics, Spine Section, Aichi Spine Hospital, Aichi Prefecture, Japan
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Xie Y, Wang X, Jian Q, Fan X, Yu Y, Gu D, Wu W. Three dimensional finite element analysis used to study the influence of the stress and strain of the operative and adjacent segments through different foraminnoplasty technique in the PELD: Study protocol clinical trial (SPIRIT Compliant). Medicine (Baltimore) 2020; 99:e19670. [PMID: 32282719 PMCID: PMC7220094 DOI: 10.1097/md.0000000000019670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Percutaneous endoscopic lumbar disectomy (PELD) is one of the most popular minimally invasive techniques of spinal surgery in recent years. At present, there are 2 main surgical approaches in PELD: foraminal approach and interlaminar approach. What's more, foraminoplasty is a necessary step for both approaches. However, there are few biomechanical studies on the formation of different parts of the intervertebral foramen. The aim of this study is to explore the effects of different foraminoplasty methods on the biomechanics of the corresponding and adjacent segments of the lumbar through a 3-dimensional finite element model analysis. METHODS We established a normal 3-dimensional finite element mode of L3 to L5, simulated lumbar percutaneous endoscopy by doing cylindrical excision of bone whose diameter was 7.5 mm on the L5 superior articular process and the L4 inferior articular process, respectively, so that we obtained 3 models: the first one was normal lumbar model, the second one was the L4 inferior articular process shaped model, and the third one was the L5 superior articular process shaped model. We compared the biomechanics of the intervertebral disc of L3/4 and L4/5 when they were in the states of forward flexion, backward extension, left and right flexion, and left and right rotation on specific loading condition. DISCUSSION If the outcomes indicate the trial is feasible and there is evidence that one of the foraminoplasty technique may make few differences in biomechanics of corresponding lumbar intervertebral disc, we will proceed to a definitive trial to test the best way to foraminplasty, which could make biomechanical influence as little as possible. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR1900026973. Registered on September 27, 2019.
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Affiliation(s)
- YiZhou Xie
- Chengdu University of Traditional Chinese Medicine
| | - Xinling Wang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province
| | - Qiang Jian
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province
| | - Xiaohong Fan
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province
| | - Yang Yu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province
| | - Dangwei Gu
- Chengdu University of Traditional Chinese Medicine
| | - WeiDong Wu
- Southern Medical University, Guangzhou, Guangdong Province, P.R. China
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20
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Lak AM, Lamba N, Pompilus F, Yunusa I, King A, Sultan I, Amamoo J, Al-Otaibi NM, Alasmari M, Zaghloul I, Aglio L, Cerecedo-Lopez CD, Tafel I, Smith TR, Mekary RA, Zaidi H. Minimally invasive versus open surgery for the correction of adult degenerative scoliosis: a systematic review. Neurosurg Rev 2020; 44:659-668. [PMID: 32166508 DOI: 10.1007/s10143-020-01280-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/14/2020] [Accepted: 03/03/2020] [Indexed: 01/11/2023]
Abstract
While open surgery has been the primary surgical approach for adult degenerative scoliosis, minimally invasive surgery (MIS) represents an alternative option and appears to be associated with reduced morbidity. Given the lack of consensus, we aimed to conduct a systematic review on available literature comparing MIS versus open surgery for adult degenerative scoliosis. PubMed, Embase, and Cochrane databases were searched through December 16, 2019, for studies that compared both MIS and open surgery in patients with degenerative scoliosis. Four cohort studies reporting on 350 patients met the inclusion criteria. In two studies, patients undergoing open surgery were younger and had more severe disease at baseline as compared with MIS. Patients who underwent MIS had less blood loss, shorter length of stay, and a reduced rate of complications and infections. Both MIS and open surgery resulted in a significant change in pain and disability scores and both approaches provided significant correction of deformity in all studies, although open surgery was associated with a greater change in pelvic incidence-lumbar lordosis mismatch (PI-LL) and sagittal vertical axis (SVA) in two and three studies, respectively. In patients with adult degenerative scoliosis undergoing surgery, both MIS and open approaches appeared to offer comparable improvements in pain and function. However, MIS was associated with better safety outcomes, while open surgery provided greater correction of spinal deformity. Further studies are needed to identify specific subset of patients who may benefit from one approach versus the other.
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Affiliation(s)
- Asad M Lak
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Nayan Lamba
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Farrah Pompilus
- Department of Pharmaceutical Business and Administrative Sciences, MCPHS University, Boston, MA, USA
| | - Ismaeel Yunusa
- Department of Pharmaceutical Business and Administrative Sciences, MCPHS University, Boston, MA, USA
| | - Andrella King
- Department of Pharmaceutical Business and Administrative Sciences, MCPHS University, Boston, MA, USA
| | - Ihtisham Sultan
- Department of Pharmaceutical Business and Administrative Sciences, MCPHS University, Boston, MA, USA
| | - James Amamoo
- Department of Pharmaceutical Business and Administrative Sciences, MCPHS University, Boston, MA, USA
| | - Nawaf M Al-Otaibi
- Department of Pharmaceutical Business and Administrative Sciences, MCPHS University, Boston, MA, USA
| | - Mohammed Alasmari
- Department of Pharmaceutical Business and Administrative Sciences, MCPHS University, Boston, MA, USA
| | - Iman Zaghloul
- Department of Pharmaceutical Business and Administrative Sciences, MCPHS University, Boston, MA, USA
| | - Linda Aglio
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Christian D Cerecedo-Lopez
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Ian Tafel
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Timothy R Smith
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Rania A Mekary
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA. .,Department of Pharmaceutical Business and Administrative Sciences, MCPHS University, Boston, MA, USA.
| | - Hasan Zaidi
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
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Zhang M, Li J, Fang T, Zhao J, Pan W, Wang X, Xu J, Zhou Q. Evaluation of a Three-Dimensional Printed Guide and a Polyoxymethylene Thermoplastic Regulator for Percutaneous Pedicle Screw Fixation in Patients with Thoracolumbar Fracture. Med Sci Monit 2020; 26:e920578. [PMID: 31932574 PMCID: PMC6982400 DOI: 10.12659/msm.920578] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the efficacy of a porous polyoxymethylene thermoplastic regulator combined with a three-dimensional (3D) printed template to guide pedicle needle insertion in patients undergoing percutaneous pedicle screw fixation (PPSF) for thoracolumbar fracture. MATERIAL AND METHODS Forty patients were randomly divided into group A, treated using a porous polyoxymethylene thermoplastic regulator combined with a 3D printed template, and group B, who underwent conventional PPSF. Data recorded included the number of pedicle screws successfully inserted on the first attempt, the number of attempts, the time to successful needle insertion, the total time of fluoroscopy, and the duration of surgery. The Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI) scores one day before surgery, and at day 1, day 7, month 1, and month 3 after surgery were recorded. The postoperative vertebral posterior kyphotic angle (KA) and the rate of change of KA were recorded. RESULTS Group A had a significantly increased total number of successful first insertions compared with group BV (P<0.05). Postoperative VAS and ODI scores of patients in both groups were significantly lower than before surgery (P<0.05), with no significant difference between the two groups at postoperative month 1 and month 3 (P>0.05). The postoperative vertebral posterior KA decreased significantly in both groups after surgery, with no significant difference between the two groups (P>0.05). CONCLUSIONS The use of a porous polyoxymethylene thermoplastic regulator combined with a 3D printed template may improve the success of pedicle insertion in patients undergoing PPSF.
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Affiliation(s)
- Ming Zhang
- Department of Orthopedic Surgery, The Second Peoples' Hospital of Huai'an, Xuzhou Medical University, Huai'an, Jiangsu, China (mainland)
| | - Jiayi Li
- Department of Orthopedic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Tao Fang
- Department of Orthopedic Surgery, The Second Peoples' Hospital of Huai'an, Xuzhou Medical University, Huai'an, Jiangsu, China (mainland)
| | - Jiali Zhao
- Department of Orthopedic Surgery, The Second Peoples' Hospital of Huai'an, Xuzhou Medical University, Huai'an, Jiangsu, China (mainland)
| | - Wei Pan
- Department of Orthopedic Surgery, The Second Peoples' Hospital of Huai'an, Xuzhou Medical University, Huai'an, Jiangsu, China (mainland)
| | - Xinhong Wang
- Department of Orthopedic Surgery, The Second Peoples' Hospital of Huai'an, Xuzhou Medical University, Huai'an, Jiangsu, China (mainland)
| | - Jin Xu
- Department of Orthopedic Surgery, The Second Peoples' Hospital of Huai'an, Xuzhou Medical University, Huai'an, Jiangsu, China (mainland)
| | - Quan Zhou
- Department of Orthopedic Surgery, The Second Peoples' Hospital of Huai'an, Xuzhou Medical University, Huai'an, Jiangsu, China (mainland)
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Measuring the performance of patient-specific solutions for minimally invasive transforaminal lumbar interbody fusion surgery. J Clin Neurosci 2019; 71:43-50. [PMID: 31843436 DOI: 10.1016/j.jocn.2019.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 10/07/2019] [Accepted: 11/09/2019] [Indexed: 01/12/2023]
Abstract
Pre-surgical planning using 3D-printed BioModels enables the preparation of a "patient-specific" kit to assist instrumented spinal fusion surgery. This approach has the potential to decrease operating time while also offering logistical benefits and cost savings for healthcare. We report our experience with this method in 129 consecutive patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) over 27 months at a single centre and performed by a single surgeon. Patient imaging and surgical planning software were used to manufacture a 3D-printed patient-specific MIS TLIF kit for each patient consisting of a 1:1 scale spine BioModel, stereotactic K-wire guide, osteotomy guide, and retractors. Pre-selected pedicle screws, rods, and cages were sourced and supplied with the patient-specific kit. Additional implants were available on-shelf to address a size discrepancy between the kit implant and intraoperative measurements. Each BioModel was used pre-operatively for surgical planning, patient consent and education. The BioModel was sterilised for intraoperative reference and navigation purposes. Efficiency measures included operating time (153 ± 44 min), sterile tray usage (14 ± 3), fluoroscopy screening time (57.2 ± 23.7 s), operative waste (19 ± 8 L contaminated, 116 ± 30 L uncontaminated), and median hospital stay (4 days). The pre-selected kit implants exactly matched intraoperative measurements for 597/639 pedicle screws, 249/258 rods, and 46/148 cages. Pedicle screw placement accuracy was 97.8% (625/639) on postoperative CT. Complications included one intraoperative dural tear, no blood products administered, and six reoperations. Our experience demonstrates a viable application of patient-specific 3D-printed solutions and provides a benchmark for studies of efficiency in spinal fusion surgery.
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Ishii K, Iwai H, Oka H, Otomo K, Inanami H. A protective method to reduce radiation exposure to the surgeon during endoscopic lumbar spine surgery. JOURNAL OF SPINE SURGERY (HONG KONG) 2019; 5:529-534. [PMID: 32043003 PMCID: PMC6989937 DOI: 10.21037/jss.2019.09.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 09/03/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Endoscopic lumbar spine surgery is a minimally invasive technique that requires intraoperative fluoroscopic imaging. Fluoroscopy is a source of ionizing radiation, and exposure of the surgeon to this radiation has a risk for radiation-induced morbidities. To reduce this radiation exposure, we developed a protective method that can be used during endoscopic lumbar spine surgery. The purpose of the study was to determine the effectiveness of this method. METHODS A prospective interventional study was performed, in which the primary outcome was radiation exposure to the surgeon [Sievert (Sv)] per case. This was measured using a radiation badge at the levels of the neck, chest, and abdomen on the surface of a protector for the surgeon in 18 endoscopic lumbar spine surgeries, including 9 each with the radiation protection method and the conventional method. Data were also collected for age, gender, body mass index, operative side, and total fluoroscopy time. Primary outcomes were compared in cases that used the radiation protection method and the conventional method. RESULTS The mean radiation exposures to the surgeon at the neck, chest, and abdomen were 1.0, 0.8 and 0.7 µSv, respectively, using the radiation protection method, and 3.2, 10.8, and 10.2 µSv, respectively, using the conventional method. The differences in exposure at all three points were significant (P=0.013, P<0.001, P<0.001, respectively). CONCLUSIONS These results show the effectiveness of the radiation protection method developed to reduce exposure of the surgeon to radiation during endoscopic lumbar spine surgery.
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Affiliation(s)
- Keisuske Ishii
- Inanami Spine and Joint Hospital, Shinagawa-ku, Tokyo, Japan
- Teikyo University Hospital, Itabashi-Ku, Tokyo, Japan
| | - Hiroki Iwai
- Inanami Spine and Joint Hospital, Shinagawa-ku, Tokyo, Japan
| | - Hiroyuki Oka
- The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Park SH, Ko MJ, Park YS, Yun J, Byun H, Park SW. A New Shielding Curtain for Protection of Intraoperative Radiation During Minimally Invasive Spine Surgery. Neurospine 2019; 17:288-293. [PMID: 31614404 PMCID: PMC7136108 DOI: 10.14245/ns.1938282.141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 09/02/2019] [Indexed: 11/26/2022] Open
Abstract
Objective Gradually increasing number of minimally invasive spine surgery (MISS), there is an increasing risk of radiation exposure to medical personnel during the surgery. We measured the radiation exposure of the operating room personnel during MISS, tried to find the riskiest person, and checked the effectiveness of a new lead-composite shielding curtain.
Methods Radiation exposure of medical staffs (operator, first assistant, anesthesiologist, and scrub nurse) involved in MISS procedures of 35 patients without shielding curtain (nonshield group) and 35 patients with shielding curtain (shield group). The shielding curtain had 0.25-mm nominal lead equivalent and was mounted on 2 frame bars fixed on the operating table.
Results In the nonshield group, radiation exposure was significantly higher in the order of operator > first assistant > scrub nurse > anesthesiologist (p < 0.001) during both anteroposterior (AP) and lateral views. In the shield group, the radiation exposure of the operator and the scrub nurse decreased significantly by 94.1% and 76.4% in AP view (p < 0.001), and by 96.3% and 73.9% in lateral view (p < 0.001), respectively.
Conclusion Since the radiation dose of the operator was highest in a C-arm-guided MISS, there is a high priority need to protect the operator from the radiation exposure. The shielding curtain could most effectively reduce the radiation exposure of the operator.
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Affiliation(s)
- Se Hoon Park
- Department of Neurosurgery, Chung-Ang University Hospital, Seoul, Korea
| | - Myeong Jin Ko
- Department of Neurosurgery, Chung-Ang University Hospital, Seoul, Korea
| | - Yong Sook Park
- Department of Neurosurgery, Chung-Ang University Hospital, Seoul, Korea
| | - Jaehan Yun
- Department of Chemical Engineering, Keimyung University, Daegu, Korea
| | - Hongsik Byun
- Department of Chemical Engineering, Keimyung University, Daegu, Korea
| | - Seung Won Park
- Department of Neurosurgery, Chung-Ang University Hospital, Seoul, Korea
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Apelmann C, Kowald B, Weinrich N, Dischinger J, Nienhaus A, Seide K, Martens H, Jürgens C. Radiation Dose to the Eye Lens Through Radiological Imaging Procedures at the Surgical Workplace During Trauma Surgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3850. [PMID: 31614696 PMCID: PMC6843242 DOI: 10.3390/ijerph16203850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/07/2019] [Accepted: 10/08/2019] [Indexed: 11/21/2022]
Abstract
Background: Due to the drastic reduction of the eye lens dose limit from 150 mSv per year to 20 mSv per year since 2018, the prospective investigation of the estimated dose of the eye lens by radiological imaging procedures at the surgical site during trauma surgery in the daily work process was carried out. This was also necessary because, as experience shows, with changes in surgical techniques, there are also changes in the use of radiological procedures, and thus an up-to-date inventory can provide valuable information for the assessment of occupationally induced radiation exposure of surgical personnel under the current conditions. Methods: The eye lens radiation exposure was measured over three months for five trauma surgeons, four hand surgeons and four surgical assistants with personalized LPS-TLD-TD 07 partial body dosimeters Hp (0.07). A reference dosimeter was deposited at the surgery changing room. The dosimeters were sent to the LPS (Landesanstalt für Personendosimetrie und Strahlenschutzausbildung) measuring institute (National Institute for Personal Dosimetry and Radiation Protection Training, Berlin) for evaluation after 3 months. The duration of the operation, occupation (assistant, surgeon, etc.), type of surgery (procedure, diagnosis), designation of the X-ray unit, total duration of radiation exposure per operation and dose area product per operation were recorded. Results: Both the evaluation of the dosimeters by the trauma surgeons and the evaluation of the dosimeters by the hand surgeons and the surgical assistants revealed no significant radiation exposure of the eye lens in comparison to the respective measured reference dosimeters. Conclusions: Despite the drastic reduction of the eye lens dose limit from 150 mSv per year to 20 mSv per year, the limit for orthopedic, trauma and hand surgery operations is well below the limit in this setting.
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Affiliation(s)
| | - Birgitt Kowald
- BG Klinikum Hamburg, Bergedorfer Str. 10, 21033 Hamburg, Germany
| | - Nils Weinrich
- BG Klinikum Hamburg, Bergedorfer Str. 10, 21033 Hamburg, Germany
| | - Jens Dischinger
- Northern German Seminar for Radiation Protection gGmbH at the Christian-Albrechts-University Kiel, 24098 Kiel, Germany
| | - Albert Nienhaus
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), University Medical Centre Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
| | - Klaus Seide
- BG Klinikum Hamburg, Bergedorfer Str. 10, 21033 Hamburg, Germany
| | - Heiko Martens
- B.A.D. Gesundheitsvorsorge und Sicherheitstechnik GmbH, 21033 Hamburg, Germany
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Barber SM, Nakhla J, Konakondla S, Fridley JS, Oyelese AA, Gokaslan ZL, Telfeian AE. Outcomes of endoscopic discectomy compared with open microdiscectomy and tubular microdiscectomy for lumbar disc herniations: a meta-analysis. J Neurosurg Spine 2019; 31:802-815. [PMID: 31491760 DOI: 10.3171/2019.6.spine19532] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 06/19/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Endoscopic discectomy (ED) has been advocated as a less-invasive alternative to open microdiscectomy (OM) and tubular microdiscectomy (TM) for lumbar disc herniations, with the potential to decrease postoperative pain and shorten recovery times. Large-scale, objective comparisons of outcomes between ED, OM, and TM, however, are lacking. The authors' objective in this study was to conduct a meta-analysis comparing outcomes of ED, OM, and TM. METHODS The PubMed database was searched for articles published as of February 1, 2019, for comparative studies reporting outcomes of some combination of ED, OM, and TM. A meta-analysis of outcome parameters was performed assuming random effects. RESULTS Twenty-six studies describing the outcomes of 2577 patients were included. Estimated blood loss was significantly higher with OM than with both TM (p = 0.01) and ED (p < 0.00001). Length of stay was significantly longer with OM than with ED (p < 0.00001). Return to work time was significantly longer in OM than with ED (p = 0.001). Postoperative leg (p = 0.02) and back (p = 0.01) VAS scores, and Oswestry Disability Index scores (p = 0.006) at latest follow-up were significantly higher for OM than for ED. Serum creatine phosphokinase (p = 0.02) and C-reactive protein (p < 0.00001) levels on postoperative day 1 were significantly higher with OM than with ED. CONCLUSIONS Outcomes of TM and OM for lumbar disc herniations are largely equivalent. While this analysis demonstrated that several clinical variables were significantly improved in patients undergoing ED when compared with OM, the magnitude of many of these differences was small and of uncertain clinical relevance, and several of the included studies were retrospective and subject to a high risk of bias. Further high-quality prospective studies are needed before definitive conclusions can be drawn regarding the comparative efficacy of the various surgical treatments for lumbar disc herniations.
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McClelland S, Goldstein JA. Minimally Invasive versus Open Spine Surgery: What Does the Best Evidence Tell Us? J Neurosci Rural Pract 2019; 8:194-198. [PMID: 28479791 PMCID: PMC5402483 DOI: 10.4103/jnrp.jnrp_472_16] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Spine surgery has been transformed significantly by the growth of minimally invasive surgery (MIS) procedures. Easily marketable to patients as less invasive with smaller incisions, MIS is often perceived as superior to traditional open spine surgery. The highest quality evidence comparing MIS with open spine surgery was examined. Methods: A systematic review of randomized controlled trials (RCTs) involving MIS versus open spine surgery was performed using the Entrez gateway of the PubMed database for articles published in English up to December 28, 2015. RCTs and systematic reviews of RCTs of MIS versus open spine surgery were evaluated for three particular entities: Cervical disc herniation, lumbar disc herniation, and posterior lumbar fusion. Results: A total of 17 RCTs were identified, along with six systematic reviews. For cervical disc herniation, MIS provided no difference in overall function, arm pain relief, or long-term neck pain. In lumbar disc herniation, MIS was inferior in providing leg/low back pain relief, rehospitalization rates, quality of life improvement, and exposed the surgeon to >10 times more radiation in return for shorter hospital stay and less surgical site infection. In posterior lumbar fusion, MIS transforaminal lumbar interbody fusion (TLIF) had significantly reduced 2-year societal cost, fewer medical complications, reduced time to return to work, and improved short-term Oswestry Disability Index scores at the cost of higher revision rates, higher readmission rates, and more than twice the amount of intraoperative fluoroscopy. Conclusion: The highest levels of evidence do not support MIS over open surgery for cervical or lumbar disc herniation. However, MIS TLIF demonstrates advantages along with higher revision/readmission rates. Regardless of patient indication, MIS exposes the surgeon to significantly more radiation; it is unclear how this impacts patients. These results should optimize informed decision-making regarding MIS versus open spine surgery, particularly in the current advertising climate greatly favoring MIS.
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Affiliation(s)
- Shearwood McClelland
- Department of Orthopaedic Surgery, NYU Langone Medical Center, Division of Spine Surgery, Hospital for Joint Diseases, New York, NY, USA
| | - Jeffrey A Goldstein
- Department of Orthopaedic Surgery, NYU Langone Medical Center, Division of Spine Surgery, Hospital for Joint Diseases, New York, NY, USA
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Computer-Assisted Instrument Navigation Versus Conventional C-Arm Fluoroscopy for Surgical Instrumentation: Accuracy, Radiation Time, and Radiation Exposure. AJR Am J Roentgenol 2019; 213:651-658. [DOI: 10.2214/ajr.18.20788] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Ultrasound-guided transforaminal percutaneous endoscopic lumbar discectomy: a new guidance method that reduces radiation doses. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:2543-2550. [DOI: 10.1007/s00586-019-05980-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/09/2019] [Accepted: 04/17/2019] [Indexed: 12/12/2022]
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Ge DH, Stekas ND, Varlotta CG, Fischer CR, Petrizzo A, Protopsaltis TS, Passias PG, Errico TJ, Buckland AJ. Comparative Analysis of Two Transforaminal Lumbar Interbody Fusion Techniques: Open TLIF Versus Wiltse MIS TLIF. Spine (Phila Pa 1976) 2019; 44:E555-E560. [PMID: 30325884 DOI: 10.1097/brs.0000000000002903] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective cohort study at a single institution. OBJECTIVE The aim of this study was to analyze the perioperative and postoperative outcomes of patients who underwent open transforaminal lumbar interbody fusion (O-TLIF) and bilateral minimally invasive surgery (MIS) Wiltse approach TLIF (Wil-TLIF). SUMMARY OF BACKGROUND DATA Several studies have compared open TLIF to MIS TLIF; however, comparing the techniques using a large cohort of one-level TLIFs has not been fully explored. METHODS We reviewed the charts of patients undergoing a single-level primary posterior lumbar interbody fusion between 2012 and 2017. The cases were categorized as Open TLIF (traditional midline exposure including lateral exposure of transverse processes) or bilateral paramedian Wiltse TLIF approach. Differences between groups were assessed by t tests. RESULTS Two hundred twenty-seven patients underwent one-level primary TLIF (116 O-TLIF, 111 Wil-TLIF). There was no difference in age, gender, American Society of Anesthesiologists (ASA), or body mass index (BMI) between groups. Wil-TLIF had the lowest estimated blood loss (EBL; 197 vs. 499 mL O-TLIF, P ≤ 0.001), length of stay (LOS; 2.7 vs. 3.6 days O-TLIF, P ≤ 0.001), overall complication rate (12% vs. 24% O-TLIF, P = 0.015), minor complication rate (7% vs. 16% O-TLIF, P = 0.049), and 90-day readmission rate (1% vs. 8% O-TLIF, P = 0.012). Wil-TLIF was associated with the higher fluoroscopy time (83 vs. 24 seconds O-TLIF, P ≤ 0.001). There was not a significant difference in operative time, intraoperative or neurological complications, extubation time, reoperation rate, or infection rate. CONCLUSION In comparing Wiltse MIS TLIF to Open TLIF, the minimally invasive paramedian Wiltse approach demonstrated the lowest EBL, LOS, readmission rates, and complications, but longer fluoroscopy times when compared with the traditional open approach. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- David H Ge
- Division of Spine Surgery, Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY
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Wu RH, Deng DH, Huang XQ, Shi CL, Liao XQ. Radiation Exposure Reduction in Ultrasound-Guided Transforaminal Percutaneous Endoscopic Lumbar Discectomy for Lumbar Disc Herniation: A Randomized Controlled Trial. World Neurosurg 2019; 124:e633-e640. [PMID: 30648611 DOI: 10.1016/j.wneu.2018.12.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/17/2018] [Accepted: 12/20/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Transforaminal percutaneous endoscopic lumbar discectomy (TF-PELD) is a minimally invasive technique with high radiation exposure. The purpose of this study was to compare radiation exposure of ultrasound-guided TF-PELD with fluoroscopy-guided TF-PELD. METHODS In this prospective randomized controlled clinical trial, 60 patients with lumbar disc herniation were enrolled and randomly assigned to 2 groups (30 cases in each group): the ultrasound-guided group or the fluoroscopy-guided group. The radiation exposure, fluoroscopy time, and visual analog scale score were recorded. The number of possible operations per year within the yearly occupational exposure limit (OEL) was calculated. We also recorded the adverse events to evaluate the safety of ultrasound-guided TF-PELD. RESULTS In 30 patients from the ultrasound-guided group, the lumbar disc structure was clearly visible under ultrasound guidance. The effective dose to surgeons and radiation dose to patients were 1.7 ± 0.4 and 25.2 ± 4.9 μSv in the ultrasound-guided group and 9.0 ± 2.5 and 127.4 ± 27.1 μSv in the fluoroscopy-guided group (P < 0.05), respectively. The fluoroscopy time was 2.6 ± 0.5 seconds in the ultrasound-guided group and 127.3 ± 29.5 seconds in the fluoroscopy-guided group (P < 0.05). A surgeon with shielding devices could treat 5556 cases per year in the fluoroscopy-guided group before exceeding the OEL for whole-body radiation, whereas they could treat 29,412 cases in the ultrasound-guided group. No difference between groups was detected in postoperative visual analog scale score (P > 0.58). No serious adverse event was found in any patient. CONCLUSIONS Ultrasound-guided TF-PELD could decrease radiation exposure to surgeons and patients, without serious adverse events. It seems to be an acceptable alternative to fluoroscopy-guided TF-PELD.
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Jiang Y, Wang HR, Wang PF, Xu SG. The Surgical Approach Visualization and Navigation (SAVN) System reduces radiation dosage and surgical trauma due to accurate intraoperative guidance. Injury 2019; 50:859-863. [PMID: 30922663 DOI: 10.1016/j.injury.2019.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 03/16/2019] [Indexed: 02/02/2023]
Abstract
OBJECT The intraoperative fluoroscopy has been widely used in modern neuro-spinal surgery due to the overwhelming trend toward minimal-access surgery. However, both patients and surgical personnel were under ionizing-radiation exposure during fluoroscopy usage. Since the fluoroscopy constitutes the vast majority of radiation exposure for both surgeons and patients, the development and improvement of new interventional possibilities are of great importance and interests. PATIENTS AND METHODS A total of 20 patients were included in the current study, who received thoracic-spinal tumor resection via posterior midline approach. In comparison to the conventional C-Arm mobile fluoroscopy machine, the Surgical Approach Visualization and Navigation (SAVN) System was used to evaluate the effectiveness in reducing radiation. RESULTS The pain intensity and Japanese Orthopedic Association Score were equally ameliorated in patients of two groups. However, compared to C-arm group, the SAVN significantly reduced the screening time from 26.8 + 12.4 to 17.1 + 9.2 s (36.2% radiation reduction, P < 0.05), which was mainly due to the significant reduction of radiation attempts (from 12.8 + 4.9 to 7.1 + 5.5 times, P < 0.05). For patients, the direct and scatter radiation dose dropped 30.4% (P < 0.05) in the surgical region and 47.6% (P < 0.01) in the non-surgical region by using the SAVN System. Additionally, the tumor diameter/skin incision ratio increased from 0.39 + 0.4 to 0.47+ 0.28 after SAVN usage. Meanwhile, thedosimeter showed that the radiation dose to the primary surgeon was also lower in the SAVN group (72.1% reduction, P < 0.01). CONCLUSION Comparing the conventional C-arm, the SAVN System based thoracic-spinal surgery significantly lowered radiation duration and dosage application towards both surgeons and patients.
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Affiliation(s)
- Ying Jiang
- Department of Neurosurgery, Shanghai Chang Zheng Hospital affiliated to China Second Military Medical University, 415 Feng Yang Rd, 200003, Shanghai, PR China.
| | - Hong-Rui Wang
- Department of Emergency Medicine, Shanghai Chang Hai Hospital affiliated to China Second Military Medical University, 168 Chang Hai Rd., 200433, Shanghai, PR China.
| | - Pan-Feng Wang
- Department of Emergency Medicine, Shanghai Chang Hai Hospital affiliated to China Second Military Medical University, 168 Chang Hai Rd., 200433, Shanghai, PR China.
| | - Shuo-Gui Xu
- Department of Emergency Medicine, Shanghai Chang Hai Hospital affiliated to China Second Military Medical University, 168 Chang Hai Rd., 200433, Shanghai, PR China.
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Kim M, Kim HS, Oh SW, Adsul NM, Singh R, Kashlan ON, Noh JH, Jang IT, Oh SH. Evolution of Spinal Endoscopic Surgery. Neurospine 2019; 16:6-14. [PMID: 31618807 PMCID: PMC6449828 DOI: 10.14245/ns.1836322.161] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 02/25/2019] [Indexed: 12/20/2022] Open
Abstract
Innovations in the development of endoscopic spinal surgery were classified into different generations and reviewed. Future developments and directions for endoscopic spinal surgery were discussed. Surgical therapy for spinal disease has been gradually changing from traditional open surgery to minimally invasive spinal surgery. Recently, endoscopic spinal surgery, which initially was limited to the treatment of soft tissue lesions, has expanded to include other aspects of spinal disease and good clinical results have been reported. As the paradigm of spinal surgery shifts from open surgery to endoscopic surgery, we discussed the evolution of endoscopic spine surgery in our literature review. Through this description, we presented possibilities of future developments and directions in endoscopic spine surgery.
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Affiliation(s)
- Manyoung Kim
- Department of Orthopaedic Surgery, The Leon Wiltse Memorial Hospital, Anyang, Korea
| | - Hyeun-Sung Kim
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Korea
| | - Sung Woon Oh
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Korea
| | | | - Ravindra Singh
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Korea
| | | | - Jung Hoon Noh
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Korea
| | - Il Tae Jang
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Korea
| | - Seong Hoon Oh
- Department of Neurosurgery, Nanoori Incheon Hospital, Incheon, Korea
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Mohammad LM, Messegee J, Chohan MO, Taylor CL. Fluoroscopic Cranial Radiation Exposure in Spine Surgery: A Prospective Single-Center Evaluation in Operating Room Personnel. Int J Spine Surg 2019; 13:28-32. [PMID: 30805283 DOI: 10.14444/6004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Cranial radiation exposure during instrumented spine surgery is not well documented. We set out to measure this risk to the patient, surgeon, surgical resident, and scrub technician during these procedures. Methods Forty-seven individuals were enrolled during a 1.5-year period between October 2014 and March 2016 at the University of New Mexico Department of Neurosurgery. Radiation doses were obtained through electronic dosimeters placed on the surgical cap over the temporal scalp (bilaterally on surgeon and resident assist, unilaterally on surgical scrub on the side facing radiation source) and on the midline of the patient's exposed cranium. Results Of the 47 procedures, 39 (83%) were open and 8 (17%) were minimally invasive or percutaneous instrumented procedures. A total of 91 motion segments were treated, with a mean of 1.9 levels per case (57% lumbosacral, 34% cervical, and 2.1% thoracic). Total fluoroscopic time was 12.9 minutes. Mean dose per case (mrem/case) was calculated for the spine surgeon (1.4), resident assist (1.4), surgical scrub (1.2), and the patient (3.6). All doses were within federal safety guidelines. A spine surgeon would need to perform more than 1400 cases per year to reach the current federal maximum permissible dose for head exposure. Conclusions There was no difference in cranial radiation exposure between operating room staff during spine surgeries. Moreover, the doses measured at the cranium were within national safety limits. Current protective technologies have significantly reduced the amount of ionizing radiation exposure during routine spine procedures; however, changes in behavior or equipment may further reduce radiation exposure to health care workers. Clinical Relevance Radiation exposure to patients and hospital staff remains a major concern in the practice of modern spine surgery. Cranial exposure remains the only established environmental risk factor for brain tumors, such as gliomas and meningiomas. Our study shows that all those exposed to radiation during spine surgery had cranial doses well within the national safety limits.
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Affiliation(s)
- Laila Malani Mohammad
- Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - James Messegee
- Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - M Omar Chohan
- Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Christopher L Taylor
- Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico
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Gowda SR, Mitchell CJ, Abouel-Enin S, Lewis C. Radiation risk amongst orthopaedic surgeons - Do we know the risk? J Perioper Pract 2018; 29:115-121. [PMID: 29944026 DOI: 10.1177/1750458918785268] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Radiation risk amongst orthopaedic surgeons and theatre personnel is increasing with increased use of fluoroscopy imaging. Increased radiation risk has been shown to be associated with an increased risk of malignancies, ocular and thyroid disorders. Very high exposures have been reported in spinal surgery and during intra-medullary nailing. With an increase in modern and percutaneous methods, the use of intra-operative fluoroscopy has increased as well. The aim of this article was to review the available evidence of radiation risk amongst healthcare personnel. A systematic search was carried out in PubMED, CINAHL and Cochrane on intra-operative radiation in trauma and orthopaedic operating room. Inclusion criteria were clinical studies and systematic reviews reporting on radiation exposure, fluoroscopy time and references to specific safety guidelines. This article highlights the safety aspects of radiation protection and harmful effects of radiation during orthopaedic procedures. The responsibility to minimise radiation exposure in operating theatre lies with the team within the operating room.
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Affiliation(s)
- Sushmith R Gowda
- 1 Department of Trauma and Orthopaedics, Royal Centre for Defence Medicine, Birmingham, UK
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Harrison Farber S, Nayar G, Desai R, Reiser EW, Byrd SA, Chi D, Idler C, Isaacs RE. Radiation exposure to the surgeon during minimally invasive spine procedures is directly estimated by patient dose. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:1911-1917. [PMID: 29948320 DOI: 10.1007/s00586-018-5653-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 05/10/2018] [Accepted: 06/01/2018] [Indexed: 12/01/2022]
Abstract
PURPOSE Radiation exposure is a necessary component of minimally invasive spine procedures to augment limited visualization of anatomy. The surgeon's exposure to ionizing radiation is not easily recognizable without a digital dosimeter-something few surgeons have access to. The aim of this study was to identify an easy alternative method that uses the available radiation dose data from the C-arm to accurately predict physician exposure. METHODS The senior surgeon wore a digital dosimeter during all minimally invasive spine fusion procedures performed over a 12-month period. Patient demographics, procedure information, and radiation exposure throughout the procedure were recorded. RESULTS Fifty-five minimally invasive spine fusions utilizing 330 percutaneous screws were included. Average radiation dose was 0.46 Rad/screw to the patient. Average radiation exposure to the surgeon was 1.06 ± 0.71 μSv/screw, with a strong positive correlation (r = 0.77) to patient dose. The coefficient of determination (r2) was 0.5928, meaning almost two-thirds of the variability in radiation exposure to the surgeon is explained by radiation exposure to the patient. CONCLUSIONS Intra-operative radiation exposure to the patient, which is easily identifiable as a continuously updated fluoroscopic monitor, is a reliable predictor of radiation exposure to the surgeon during percutaneous screw placement in minimally invasive spinal fusion surgery and therefore can provide an estimate of exposure without the use of a dosimeter. With this, a surgeon can better understand the magnitude of their exposure on a case-by-case basis rather than on a quarterly basis, or more likely, not at all. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- S Harrison Farber
- Department of Neurosurgery, Duke University Medical Center, Box 3807, Durham, NC, 27710, USA
| | - Gautam Nayar
- Department of Neurosurgery, Duke University Medical Center, Box 3807, Durham, NC, 27710, USA
| | - Rupen Desai
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Elizabeth W Reiser
- Department of Neurosurgery, Duke University Medical Center, Box 3807, Durham, NC, 27710, USA
| | - Sarah A Byrd
- Department of Neurosurgery, Duke University Medical Center, Box 3807, Durham, NC, 27710, USA
| | - Deborah Chi
- Department of Neurosurgery, Duke University Medical Center, Box 3807, Durham, NC, 27710, USA
| | - Cary Idler
- Department of Neurosurgery, Duke University Medical Center, Box 3807, Durham, NC, 27710, USA
| | - Robert E Isaacs
- Department of Neurosurgery, Duke University Medical Center, Box 3807, Durham, NC, 27710, USA.
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Chen J, Jing X, Li C, Jiang Y, Cheng S, Ma J. Percutaneous Endoscopic Lumbar Discectomy for L5S1 Lumbar Disc Herniation Using a Transforaminal Approach Versus an Interlaminar Approach: A Systematic Review and Meta-Analysis. World Neurosurg 2018; 116:412-420.e2. [PMID: 29783008 DOI: 10.1016/j.wneu.2018.05.075] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/09/2018] [Accepted: 05/10/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Several studies have compared the clinical efficacy of percutaneous endoscopic lumbar discectomy for L5-S1 lumbar disc herniation (LDH) using a transforaminal approach with an interlaminar approach, but with contradictory results. The aim of this study was to explore the comparison of efficacy and safety between percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID) for L5-S1 LDH. METHODS Six common databases were comprehensively searched, and relevant studies were included into the analysis when they met all the inclusion criteria. RESULTS Nine studies involving 621 patients were included into the study. The results indicated that PETD was significantly associated with greater fluoroscopy times (mean difference [MD], 9.28 times; 95% confidence interval [CI], 6.84-11.71; P < 0.01) and longer operative time (MD, 16.51 minutes; 95% CI, 4.01-29.02; P = 0.01) compared with PEID. However, there were no distinct differences between PETD and PEID in estimated blood loss (P = 0.24), bed time after surgery (P = 0.32), hospitalization time (P = 0.27), or MacNab evaluation (P = 0.78). Similarly, no obvious differences were detected between PETD and PEID regarding Visual Analogue Scale score, Japanese Orthopedic Association (JOA) score, or Oswestry Disability Index (ODI) when measured preoperatively, 1 day postoperatively, 3 months postoperatively, or at the last follow up. In addition, no significant difference was found regarding overall incidence of complications between PETD and PEID (P = 0.14). Nevertheless, a significantly lower incidence rate of dural tear was observed in PETD compared with PEID (P = 0.04). CONCLUSIONS PETD had comparable clinical efficacy and safety compared with PEID; however, PEID was superior to PETD regarding fluoroscopy times and operative time. Therefore, PEID might be a better surgical procedure for L5S1 LDH.
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Affiliation(s)
- Jiageng Chen
- Department of Health Statistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Xiyue Jing
- Department of Health Statistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Changping Li
- Department of Health Statistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yu Jiang
- Department of Orthopedics, Nanjing Medical University Affiliated Wuxi Second Hospital, Wuxi, China
| | - Sijin Cheng
- Tongji University School of Medicine, Shanghai, China
| | - Jun Ma
- Department of Health Statistics, School of Public Health, Tianjin Medical University, Tianjin, China.
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Intraoperative Computed Tomography Navigational Assistance for Transforaminal Endoscopic Decompression of Heterotopic Foraminal Bone Formation After Oblique Lumbar Interbody Fusion. World Neurosurg 2018; 115:29-34. [PMID: 29626680 DOI: 10.1016/j.wneu.2018.03.188] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 11/21/2022]
Abstract
Transforaminal endoscopic spine surgery is an emerging technique in spine surgery, but it offers 2 distinct challenges to spine surgeons looking to adopt it: 1) targeting spine pathology and 2) understanding the endoscopic anatomy visualized through the endoscope. Intraoperative computed tomography (CT)-guided navigation is also an emerging technique in spine surgery that is becoming widely adopted for its benefits in assisting surgeons in localizing pathology and guided spine instrumentation placement. In this technical note, we describe a technique that uses intraoperative CT-guided navigation concomitantly with a transforaminal endoscopic approach to decompress a L4-L5 foraminal heterotopic bone formation after an oblique lumbar interbody fusion. The addition of intraoperative CT-guided navigation proved beneficial in targeting the pathology during the procedure and ensuring that the pathology was resolved by offering postoperative CT visualization of the decompressed neural foramen.
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Darius S, Meyer F, Böckelmann I. [Hazard assessment and occupational safety measures in surgery : Relevant knowledge on occupational medicine]. Chirurg 2018; 87:948-955. [PMID: 27316708 DOI: 10.1007/s00104-016-0205-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Surgeons routinely work in an environment with occupational risks and hazards about which they are often uninformed. Based on the currently available scientific literature this review article describes the various hazards in the operating theater and their effects on personnel, particularly from the surgical perspective. A further aim of this article is to describe the occupational safety measures to reduce the burdens and to maintain the long-term health of personnel. Ultimately, surgeons should be equipped with the necessary knowledge for implementing hazard assessments according to the German Occupational Health and Safety Act. Surgeons are exposed to increased risks and hazards by working in awkward positions with a high risk for musculoskeletal pain and injuries. They are also commonly exposed to inhalational anesthetics, surgical smoke, radiation, noise and infectious agents. Furthermore, the mental and emotional stress associated with these activities is also high. Meaningful occupational safety measures for reduction of burdens are from a technical aspect the installation of effective air extraction systems, measures to reduce exposure to radiation and noise and the use of safer instruments to prevent needle stick injuries. Furthermore, individual occupational safety measures, such as the use of personal protective equipment (e.g. radiation protective clothing and double gloves) must be observed. The consistent implementation and also adherence to these described occupational safety measures and regulations can reduce the burden on operating theater personnel and contribute to maintaining health. Furthermore, periodic preventive healthcare controls and health checks by the company medical officer and individually initiated additional prevention measures can be a sensible augmentation to these safety measures.
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Affiliation(s)
- S Darius
- Bereich Arbeitsmedizin, Medizinische Fakultät, Otto-von-Guericke-Universität, Leipziger Str. 44, 39120, Magdeburg, Deutschland.
| | - F Meyer
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Magdeburg A.ö.R, Magdeburg, Deutschland
| | - I Böckelmann
- Bereich Arbeitsmedizin, Medizinische Fakultät, Otto-von-Guericke-Universität, Leipziger Str. 44, 39120, Magdeburg, Deutschland
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Yamashita K, Higashino K, Hayashi H, Hayashi F, Fukui Y, Sairyo K. Pulsation and Collimation During Fluoroscopy to Decrease Radiation: A Cadaver Study. JB JS Open Access 2017; 2:e0039. [PMID: 30229232 PMCID: PMC6133148 DOI: 10.2106/jbjs.oa.17.00039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Awareness of the harmful effects of long-term low-dose radiation is rising. Many studies have assessed both patient and physician exposure to radiation in association with the use of fluoroscopy in the operating room. However, to our knowledge, previous studies have not assessed, in a detailed fashion, the reduction in radiation exposure that pulsation and collimation provide. Methods Seven fresh cadavers were irradiated for 5 minutes with C-arm fluoroscopy with use of standard x-ray and pulsed and collimated x-ray beams. The x-ray sources were placed under the table, over the table, and lateral to the table. Radiation exposure doses were measured at different points, such as the center of the radiation field on the cadaver as well as at the locations of the surgeon's hand and thyroid gland. In addition, Monte Carlo simulation (a physics equation to predict exposure) was performed to estimate the dose reduction and to confirm the experimental results. Results The radiation exposure doses associated with the use of pulsed fluoroscopy (8 times per second) were reduced by approximately 30% for the patient and by approximately 70% for the surgeon's hand and thyroid gland as compared with those associated with the use of continuous fluoroscopy. The radiation exposure doses associated with the use of collimated beams were reduced to approximately 65% for the surgeon's hand and thyroid gland as compared with those associated with the use of non-collimated fluoroscopy. These results were consistent with the simulation, and the phenomena could be appropriately explained by physics. Conclusions The present study revealed the effectiveness of pulsed and collimated x-ray beams in reducing radiation exposure doses resulting from C-arm fluoroscopy. Surgeons should consider using the techniques of pulsed fluoroscopy and collimation to protect patients and themselves from radiation. Clinical Relevance This study presents data regarding the reduction of radiation exposure provided by pulsed fluoroscopy and collimation.
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Affiliation(s)
- Kazuta Yamashita
- Departments of Orthopedics (K.Y., K.H., F.H., and K.S.), Biomedical Science and Technology (H.H.), and Anatomy (Y.F.), Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Kosaku Higashino
- Departments of Orthopedics (K.Y., K.H., F.H., and K.S.), Biomedical Science and Technology (H.H.), and Anatomy (Y.F.), Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Hiroaki Hayashi
- Departments of Orthopedics (K.Y., K.H., F.H., and K.S.), Biomedical Science and Technology (H.H.), and Anatomy (Y.F.), Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Fumio Hayashi
- Departments of Orthopedics (K.Y., K.H., F.H., and K.S.), Biomedical Science and Technology (H.H.), and Anatomy (Y.F.), Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Yoshihiro Fukui
- Departments of Orthopedics (K.Y., K.H., F.H., and K.S.), Biomedical Science and Technology (H.H.), and Anatomy (Y.F.), Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Koichi Sairyo
- Departments of Orthopedics (K.Y., K.H., F.H., and K.S.), Biomedical Science and Technology (H.H.), and Anatomy (Y.F.), Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
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Ren C, Li Y, Qin R, Sun P, Wang P. Transforaminal Endoscopic Lumbar Discectomy for Lumbar Disc Herniation Causing Bilateral Symptoms. World Neurosurg 2017; 106:413-421. [DOI: 10.1016/j.wneu.2017.06.191] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/28/2017] [Accepted: 06/30/2017] [Indexed: 11/26/2022]
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Matityahu A, Duffy RK, Goldhahn S, Joeris A, Richter PH, Gebhard F. The Great Unknown-A systematic literature review about risk associated with intraoperative imaging during orthopaedic surgeries. Injury 2017. [PMID: 28648410 DOI: 10.1016/j.injury.2017.04.041] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Modern techniques in orthopaedic surgery using minimally invasive procedures, and increased use of fluoroscopic imaging present a potential increased risk to surgeons due to ionizing radiation exposure. This article is a systematic review of recent literature on radiation exposure of orthopaedic surgeons. MATERIALS AND METHODS Pubmed and Cochrane searches were performed on intraoperative radiation exposure covering English and German articles published between 1.1.2000 and 11.8.2014. Inclusion criteria were clinical studies and systematic literature reviews focusing on radiation exposure of orthopaedic surgeons during surgical procedures of the musculoskeletal system reporting either effective dose (whole body) or equivalent dose at the organ level. All included articles were reviewed with focus on the surgical specialty, the procedure type, the imaging system used, the radiation measurement method, the fluoroscopy time, the radiation exposure, the use of radiation protection, and any references to specific safety guidelines. RESULTS Thirty-four eligible publications were identified. However, the lack of well-designed studies focusing on radiation exposure of surgeons prevents pooling of data. Highest exposure and subsequent equivalent doses were reported from spinal surgery (up to 4.8mSv of equivalent dose to the hand) and intramedullary nailing (up to 0.142mSV of equivalent dose to the thyroid). Radiation exposure was reduced by 96.9% and 94.2% when wearing a thyroid collar and a lead apron. CONCLUSIONS With the increasing use of intraoperative imaging, there is a growing need for radiation awareness by the operating surgeon. Strict adherence to radiation protection should be enforced to protect in-training surgeons. Strategies to reduce exposure include C-arm position, distance, protective wear, and new imaging technologies. Radiation exposure is harmful and action should be taken to minimize exposure.
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Affiliation(s)
- Amir Matityahu
- San Francisco General Hospital-Orthopaedic Trauma Institute, San Francisco, CA, USA.
| | - Ryan K Duffy
- San Francisco General Hospital-Orthopaedic Trauma Institute, San Francisco, CA, USA
| | - Sabine Goldhahn
- AO Clinical Investigation and Documentation, AO Foundation, Dübendorf, Switzerland
| | - Alexander Joeris
- AO Clinical Investigation and Documentation, AO Foundation, Dübendorf, Switzerland
| | - Peter H Richter
- Department for Orthopaedic Trauma, Ulm University, Ulm, Germany
| | - Florian Gebhard
- Department for Orthopaedic Trauma, Ulm University, Ulm, Germany
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Comparative Study of C-Arms for Intraoperative 3-dimensional Imaging and Navigation in Minimally Invasive Spine Surgery Part II: Radiation Exposure. Clin Spine Surg 2017. [PMID: 28632552 DOI: 10.1097/bsd.0000000000000187] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN A radiation exposure study in vitro. OBJECTIVE This study aimed to compare the radiation exposure of 2 different 3-dimensional (3D) C-arm devices on an anthropomorphic phantom. SUMMARY OF BACKGROUND DATA Minimally invasive pedicle screw placement requires intraoperative imaging techniques for visualization of the unexposed spine. Mobile 3D C-arms compose a 3D image data set out of multiple successive fluoroscopic images. METHODS We compared the 3D C-arm devices Siremobil Iso-C 3D (Siemens Sector Healthcare, Erlangen, Germany) and Vision FD Vario 3D (Ziehm Imaging, Nuremberg, Germany) regarding their radiation exposure. For this purpose, dosimeters were attached on an anthropomorphic phantom at various sites (eye lenses, thyroid gland, female, and male gonads). With each C-arm, 10 automated 3D scans as well as 400 fluoroscopic images were performed on the cervical and lumbar spine, respectively. RESULTS The Vision FD Vario 3D generally causes higher radiation exposures than the Siremobil Iso-C 3D. Significantly higher radiation exposures were assessed at the eye lenses performing cervical (294.1 vs. 84.6 μSv) and lumbar 3D scans (22.5 vs. 11.2 μSv) as well as at the thyroid gland performing cervical 3D scans (4405.2 vs. 2761.9 μSv). Moreover, the Vision FD Vario 3D caused significantly higher radiation exposure at the eye lenses for standard cervical fluoroscopic images (3.2 vs. 0.4 μSv). CONCLUSIONS 3D C-arms facilitate minimally invasive and accurate pedicle screw placement by providing 3D image datasets for intraoperative 3D imaging and navigation. However, the hereby potentially increased radiation exposure has to be considered. In particular, the Vision FD Vario 3D appears to generally evoke higher radiation exposures than the Siremobil Iso-C 3D. Well-indicated application of ionizing radiation and compliance with radiation protection principles remain mandatory to keep radiation exposure to patient and staff as low as reasonably achievable.
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Fan G, Zhang H, Gu X, Wang C, Guan X, Fan Y, He S. Significant reduction of fluoroscopy repetition with lumbar localization system in minimally invasive spine surgery: A prospective study. Medicine (Baltimore) 2017; 96:e6684. [PMID: 28538369 PMCID: PMC5457849 DOI: 10.1097/md.0000000000006684] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The conventional location methods for minimally invasive spinal surgery (MISS) were mainly based on repeated fluoroscopy in a trial-and-error manner preoperatively and intraoperatively. Localization system mainly consisted of preoperative applied radiopaque frame and intraoperative guiding device, which has the potential to minimize fluoroscopy repetition in MISS. The study aimed to evaluate the efficacy of a novel lumbar localization system in reducing radiation exposure to patients.Included patients underwent minimally invasive transforaminal lumbar interbody fusion (MISTLIF) or percutaneous transforaminal endoscopic discectomy (PTED). Patients treated with novel localization system were regarded as Group A, and patients treated without novel localization system were regarded as Group B.For PTED, The estimated effective dose was 0.41 ± 0.13 mSv in Group A and 0.57 ± 0.14 mSv in Group B (P < .001); the fluoroscopy exposure time of PTED was 22.18 ± 7.30 seconds in Group A and 30.53 ± 7.56 seconds in Group B (P < .001); The estimated cancer risk of radiation exposure was 22.68 ± 7.38 (10) in Group A and 31.20 ± 7.96 (10) in Group B (P < .001). For MISTLIF, the estimated effective dose was 0.45 ± 0.09 mSv in Group A and 0.58 ± 0.09 mSv in Group B (P < .001); The fluoroscopy exposure time was 25.41 ± 5.52 seconds in Group A and 32.82 ± 5.03 seconds in Group B (P < .001); The estimated cancer risk was 24.90 ± 5.15 (10) in Group A and 31.96 ± 5.04 (10) in Group B (P < .001). There were also significant differences in localization time and operation time between the 2 groups either for MISTLIF or PTED.The lumbar localization system could be a potential protection strategy for minimizing radiation hazards.
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Wu R, Liao X, Xia H. Radiation Exposure to the Surgeon During Ultrasound-Assisted Transforaminal Percutaneous Endoscopic Lumbar Discectomy: A Prospective Study. World Neurosurg 2017; 101:658-665.e1. [PMID: 28342919 DOI: 10.1016/j.wneu.2017.03.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 03/13/2017] [Accepted: 03/14/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine the radiation dose to the surgeon during ultrasound-assisted transforaminal percutaneous endoscopic lumbar discectomy (PELD) for lumbar disc herniation, and to investigate whether the usage of ultrasonography could reduce the radiation exposure to the surgeon. METHODS The stages of needle insertion and foraminal plasty for transforaminal PELD were performed under ultrasound guidance and confirmed by fluoroscopy according to the standard technique by 2 spinal surgeons separately in 25 transforaminal PELDs (25 levels). The radiation exposure dose of the surgeons' chest above and below the shielding and the fluoroscopy time were recorded. The effective dose and number of possible levels per year within the yearly occupational exposure limit (OEL) were calculated. The radiation dose per level and fluoroscopy time between ultrasound-assisted PELD and fluoroscopy-assisted PELD were compared. RESULTS The mean operation time and fluoroscopy time were 67.6 ± 14.6 minutes and 2.9 ± 0.7 seconds, respectively. The mean effective dose to the surgeons per level was 1.3 ± 0.6 μSv. One surgeon could perform PELDs at 38,462 levels per year without exceeding the OEL for whole-body radiation wearing a lead apron, and 1938 levels per year without using any shielding devices. Ultrasound-assisted PELD had significantly less radiation dose per level at the chest below and above apron, effective dose per level, and fluoroscopy time, compared with fluoroscopy-assisted PELD (all P < 0.05). CONCLUSIONS The method of ultrasound-assisted needle insertion and foraminal plasty in transforaminal PELD can reduce radiation exposure to the surgeons compared with fluoroscopy-assisted PELD.
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Affiliation(s)
- Ruihui Wu
- Department of Orthopedics, Southern Medical University, Guangzhou, P.R. China; Department of Orthopedics, First People's Hospital of Foshan, Foshan, P.R. China
| | - Xuqiang Liao
- Department of Orthopedics, First People's Hospital of Foshan, Foshan, P.R. China
| | - Hong Xia
- Department of Orthopedics, Southern Medical University, Guangzhou, P.R. China; Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, P.R. China.
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Metaxas VI, Messaris GA, Gatzounis GD, Panayiotakis GS. Patient Dose in Fluoroscopically Guided Cervical Discectomy and Fusion. RADIATION PROTECTION DOSIMETRY 2017; 174:575-582. [PMID: 27613745 DOI: 10.1093/rpd/ncw257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 08/10/2016] [Indexed: 06/06/2023]
Abstract
Cervical discectomy and fusion (CDF) is a minimally invasive procedure, where the accurate placement of the implants is accomplished using fluoroscopic guidance. Therefore, the evaluation of the radiation dose becomes mandatory. The purpose of the current study was to assess patient dose during fluoroscopically guided anterior and/or posterior CDF procedures. Thirty-three patients undergoing single or multiple-level CDF were studied using a mobile C-arm system. Data regarding fluoroscopy time (FT), air kerma area product (KAP) and cumulative dose (CD) were recorded. Patient entrance surface dose (ESD), thyroid absorbed dose and effective dose (ED) were calculated from KAP measurements, utilizing the CALDoseX software. The average FT was 0.12 min (range 0.02-0.48 min), resulting to a KAP value of 0.21 Gy cm2 (range 0.01-1.46 Gy cm2) and a CD value of 0.96 mGy (range 0.04-6.58 mGy). The ESD ranged between 0.08 and 13.58 mGy (average 1.95 mGy), the ED between 0.001 and 0.097 mSv (average 0.015 mSv), while the dose absorbed by the thyroid ranged between 0.01 and 1.12 mGy (average 0.194 mGy). The dose associated with the CDF procedure is very low, comparable to that delivered by a lateral X-ray radiograph of the cervical spine. However, higher doses can be revealed, due to the non-optimum use of the X-ray system and extended FTs, mainly affected by complex clinical conditions, as well as the experience of the neurosurgeon. Additional studies need to be conducted for further investigation of the patient dose from the CDF procedure.
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Affiliation(s)
- Vasileios I Metaxas
- Department of Medical Physics, School of Medicine, University of Patras, 265 04 Patras, Greece
| | - Gerasimos A Messaris
- Department of Medical Physics, School of Medicine, University of Patras, 265 04 Patras, Greece
| | - George D Gatzounis
- Department of Neurosurgery, School of Medicine, University of Patras, 265 04 Patras, Greece
| | - George S Panayiotakis
- Department of Medical Physics, School of Medicine, University of Patras, 265 04 Patras, Greece
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Iprenburg M, Wagner R, Godschalx A, Telfeian AE. Patient radiation exposure during transforaminal lumbar endoscopic spine surgery: a prospective study. Neurosurg Focus 2016; 40:E7. [PMID: 26828888 DOI: 10.3171/2015.11.focus15485] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to describe patient radiation exposure during single-level transforaminal endoscopic lumbar discectomy procedures at levels L2-5 and L5-S1. METHODS Radiation exposure was monitored in 151 consecutive patients undergoing single-level transforaminal endoscopic lumbar discectomy procedures. Two groups were studied: patients undergoing procedures at the L4-5 level or above and those undergoing an L5-S1 procedure. RESULTS For the discectomy procedures at L4-5 and above, the average duration of fluoroscopy was 38.4 seconds and the mean calculated patient radiation exposure dose was 1.5 mSv. For the L5-S1 procedures, average fluoroscopy time was 54.6 seconds and the mean calculated radiation exposure dose was 2.1 mSv. The average patient radiation exposure dose among these cases represents a 3.5-fold decrease compared with the senior surgeon's first 100 cases. CONCLUSIONS Transforaminal lumbar endoscopic discectomy can be used as a minimally invasive technique for the treatment of lumbar radiculopathy in the setting of a herniated lumbar disc without the significant concern of exposing the patient to harmful doses of radiation. One caveat is that both the surgeon and the patient are likely to be exposed to higher doses of radiation during a surgeon's early experience in minimally invasive endoscopic spine surgery.
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Affiliation(s)
| | - Ralf Wagner
- Ligamenta Spine Centre, Frankfurt am Main, Germany; and
| | | | - Albert E Telfeian
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Percutaneous Endoscopic Lumbar Discectomy for L5-S1 Disc Herniation Via an Interlaminar Approach Versus a Transforaminal Approach: A Prospective Randomized Controlled Study With 2-Year Follow Up. Spine (Phila Pa 1976) 2016; 41 Suppl 19:B30-B37. [PMID: 27454540 DOI: 10.1097/brs.0000000000001810] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
STUDY DESIGN A prospective, randomized controlled study of patients with L5-S1 lumbar disc herniations, operated with endoscopic discectomy through an interlaminar or transforaminal approach. OBJECTIVE To compare the results of percutaneous endoscopic lumbar discectomy in L5-S1 disc herniation through an interlaminar or transforaminal approach. SUMMARY OF BACKGROUND DATA The transforaminal and interlaminar techniques are both acceptable approaches for L5-S1 disc herniation. This is the first study to compare these two approaches in terms of their surgical effects and advantages. METHODS From January 2010 to June 2010, 60 patients with L5-S1 disc herniation were randomly recruited into two groups; one group underwent percutaneous endoscopic interlaminar discectomy (PEID) and the other group underwent percutaneous endoscopic transforaminal discectomy (PETD). There were 30 patients in each group. The operation time, intraoperative radiation time, postoperative bed rest time, hospitalization time, and complications were compared between the groups. The surgical effectiveness was assessed according to the Oswestry Disability Index (ODI), Visual Analog Scale (VAS), and modified MacNab criteria. RESULTS All the patients completed follow up with a mean of 27.6 months (range, 24-37 months). In the PEID group, the mean operation time was 65.0 ± 14.9 minutes, and the intraoperative radiation time was 0.60 ± 0.24 seconds. For the PETD group, the mean operation time was 86.0 ± 15.4 minutes, and the intraoperative radiation time was 6.50 ± 1.52 seconds. There were significant differences in operation time and radiation time between the two groups (P < 0.01) but not in the postoperative bed rest time, hospitalization time, or complication rate (P > 0.05). The postoperative ODI and VAS were obviously improved in both groups when compared with preoperation (P < 0.01). According to the MacNab criteria, the satisfactory rates were 93.3% and 90.0% in the two groups, without a significant difference (P > 0.05). CONCLUSION PEID can escape the blockade of crista iliaca, and advantages include a faster puncture orientation, a shorter operation time, and less intraoperative radiation exposure. PETD requires higher punctuation skill and more intraoperative radiation exposure. LEVEL OF EVIDENCE 4.
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