Radiation Exposure during Percutaneous Endoscopic Lumbar Discectomy: Interlaminar versus Transforaminal

Abstract

Objective Percutaneous endoscopic lumbar discectomy (PELD) relies heavily on fluoroscopy guidance; therefore, medical staff exposure to radiation has become an important issue. The purpose of this study was to determine the radiation dose and the amount of time to which the surgeons are exposed during PELD and to compare both parameters in the transforaminal (TF) and interlaminar (IL) approaches. Although they are considerably different, they may be wrongly considered together.

Methods A retrospective evaluation of the last 20 PELD performed by the authors is presented. Patients were distributed in 2 groups. Six (1F, 5M) patients were submitted to IL-PELD and 14 (6F, 8M) to TF-PELD. Fluoroscopy reports were obtained from patients' records, all performed with the same C-Arm device and software mode. Groups were compared using unpaired t-test.

Results The IL group showed an average radiation exposure of 8.37 ± 4.21 mGy and duration of 11.1 ± 5.45 seconds, while the TF group showed an average radiation exposure of 28.92 ± 7.56 mGy and duration of 42 ± 16.64 seconds. The p-value for radiation was 0.0000036, and for time it was 0.00027.

Conclusions Interlaminar PELD requires a lower radiation dose and a shorter amount of exposure than TF-PELD. Studies that concern radiation required for minimally-invasive spine surgeries should consider the PELD approaches separately.

Resumo

Objetivo A discectomia endoscópica lombar percutânea (DELP) depende muito de orientação por fluoroscopia; portanto, a exposição à radiação se tornou um assunto importante. O objetivo deste estudo foi determinar a dose e o tempo de radiação aos quais os cirurgiões estão expostos durante a discectomia endoscópica lombar percutânea (DELP) e comparar ambos os parâmetros nos acessos transforaminal (TF) e interlaminar (IL). Embora sejam consideravelmente diferentes, estes podem ser erroneamente considerados em conjunto.

Métodos Avaliação retrospectiva dos últimos 20 casos de DELP realizados pelos autores. Os paciente foram distribuídos em dois grupos. Seis (1M, 5H) pacientes foram submetidos a DELP-IL e 14 (6M, 8H) a DELP-TF. Os dados da fluoroscopia foram obtidos dos relatórios dos pacientes, todos avaliados usando o mesmo aparelho de arco cirúrgico e no mesmo modo do programa. Os grupos foram comparados utilizando o teste-t não pareado.

Resultados O grupo IL mostrou exposição média à radiação de 8,37 ± 4,21 mGy e duração de 11,1 ± 5,45 segundos, enquanto o grupo TF apresentou exposição média à radiação de 28,92 ± 7,56 mGy e duração de 42 ± 16.64 segundos. O valor de p para a radiação foi de 0.0000036 e para o tempo foi de 0.00027.

Conclusões A DELP-IL necessita de menor quantidade de radiação e tempo do que a DELP-TF. Estudos cujo interesse é a radiação para cirurgias minimamente invasivas da coluna devem considerar os diferentes acessos para DELP separadamente.

Keywords

intervertebral disc displacement - fluoroscopy - background radiation - artroscopy

Palavras-chave

deslocamento do disco intervertebral - fluoroscopia - radiação de fundo - artroscopia

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