Abstract
The aim of the present study was to compare the radiation exposure of the surgeon
when using two different kyphoplasty systems for the minimally invasive treatment
of osteoporotic vertebral body fractures. There was a preliminary investigation study
by a Belgian working group from the ORAMED project (2010), which served as the basis
and showed a dose reduction for the surgeon when using a balloon kyphoplasty system
with cement delivery systems (CDS).
Materials and Methods A bipedicular balloon kyphoplasty system (Medtronic GmbH) with CDS and a unipedicular
radiofrequency kyphoplasty system (StabiliT, DFine Europe GmbH) were used in solitary
fractures in the thoracolumbar junction in 20 patients each. The patient groups were
relatively homogeneous with a mean age of 76.9 years for balloon kyphoplasty and 75
years for radiofrequency kyphoplasty. As expected, the proportion of woman was higher
in both groups. The mean BMI value was higher in the radiofrequency kyphoplasty group,
and the patient with the highest BMI was also in this group. The workflows were defined
in three steps. The working time and the fluoroscopic time were measured in the individual
work steps and the dose was measured over all work steps by TLD chips (thermoluminescence
detector) on the forehead, on the X-ray apron, on both wrists and on the left ankle.
The dose area product was registered for the entire procedure.
Results In step 2, the main differences were found in working time and fluoroscopy time in
transit. The difference was due to the bipedicular puncture for balloon kyphoplasty
and the change of the working cannula, while only a unipedicular puncture was needed
in radiofrequency kyphoplasty. The total fluoroscopy time over all procedures was
three times longer than in balloon kyphoplasty and this was also reflected in the
dose area product, which was more than twice that. The measured surface doses for
the lenses were four times higher in balloon kyphoplasty. For the left wrist, the
values for balloon kyphoplasty were about 8 times higher.
Conclusion Overall, from a radiophysical perspective, the use of a unipedicular kyphoplasty
system must be recommended. Should balloon kyphoplasty be used for medical reasons,
all radiation protection products (lead gloves, lead glass, radiation protection goggles
and CDS) should be used, the surface doses for both hands must be detected by a ring
dosimeter and the lens dose must be recorded and documented by a TLD on the radiation
protection goggles.
Key Points:
Unipedicular kyphoplasty systems would be the better options for radiation protection
reasons.
Specific medical indications may justify the use of a bipedicular kyphoplasty system
on a case-by-case basis.
The use of a ballon kyphoplasty system without CDS is no longer recommended.
When using a bipendicular kyphoplasty system, the surface doses for the hands and
the lens must be documented.
Citation Format
Reißberg S, Lüdeke L, Fritsch M. Comparison of Radiation Exposure of the Surgeon in
Minimally Invasive Treatment of Osteoporotic Vertebral Fractures – Radiofrequency
Kyphoplasty versus Balloon Kyphoplasty with Cement Delivery Systems (CDS). Fortschr
Röntgenstr 2020; 192: 59 – 64
Key words kyphoplasty - radiation safety - technical aspects - spine
