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J Neurol Surg A Cent Eur Neurosurg 2022; 83(01): 006-012
DOI: 10.1055/s-0041-1726111
Original Article

Collimation Reduces Radiation Exposure to the Surgeon in Endoscopic Spine Surgery: A Prospective Study

H. Yener Erken
1   Department of Orthopaedics and Traumatology, Faculty of Medicine, Çanakkale Onsekiz Mart University, Canakkale, Turkey
,
Onur Yilmaz
1   Department of Orthopaedics and Traumatology, Faculty of Medicine, Çanakkale Onsekiz Mart University, Canakkale, Turkey
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Abstract

Background and Study Aims There are no previous studies in the literature comparing the radiation dose to which surgeons are exposed while using a standard fluoroscopy versus collimation during transforaminal percutaneous endoscopic lumbar diskectomy (PELD). The aim of this study is to compare this and to evaluate the effectiveness of collimation in reducing radiation exposure.

Methods In this study, the operating surgeon (single surgeon) placed a gamma radiation dosimeter on his chest outside of the lead apron during transforaminal PELD surgeries and measured the radiation exposure immediately after each surgery. As foraminoplasty using free-hand reamers is a longer procedure and requires more fluoroscopy shots, we divided the patients into two groups. The first group consisted of 24 patients (nonforaminoplasty group). The second group consisted of 13 patients (foraminoplasty group). We compared the radiation exposure to the operating surgeon using a standard fluoroscopy versus collimation for each group individually and overall. We randomized the patients within each group based on the order in which they had their respective procedures.

Results We analyzed 39 patients who underwent transforaminal PELD between May and December 2019. In both groups, as well as overall, the recorded radiation exposure to the surgeon was significantly lower in surgeries in which collimation was used. In the first group, the radiation dose was 0.083 versus 0.039 mSv per surgery (p = 0.019), whereas in the second group, it was 0.153 versus 0.041 mSv per surgery (p = 0.001), and overall it was 0.108 versus 0.039 mSv per surgery (p < 0.001).

Conclusion The use of collimation during transforaminal PELD significantly reduces spine the surgeon's exposure to radiation. Therefore, spine surgeons should consider using collimation during transforaminal PELD.

Keywords

collimation - PELD - radiation exposure - spine surgery


Publication History

Received: 30 June 2020

Accepted: 28 October 2020

Article published online:
24 May 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Kambin P, Sampson S. Posterolateral percutaneous suction-excision of herniated lumbar intervertebral discs. Report of interim results. Clin Orthop Relat Res 1986; (207) 37-43
    PubMedGoogle Scholar
  • 2 Ahn Y, Lee SH, Park WM, Lee HY. Posterolateral percutaneous endoscopic lumbar foraminotomy for L5-S1 foraminal or lateral exit zone stenosis. Technical note. J Neurosurg 2003; 99 (3, Suppl): 320-323
    CrossrefPubMedGoogle Scholar
  • 3 Kim JS, Choi G, Lee SH. Percutaneous endoscopic lumbar discectomy via contralateral approach: a technical case report. Spine 2011; 36 (17) E1173-E1178
    CrossrefPubMedGoogle Scholar
  • 4 Lee SH, Kang HS, Choi G. et al. Foraminoplastic ventral epidural approach for removal of extruded herniated fragment at the L5-S1 level. Neurol Med Chir (Tokyo) 2010; 50 (12) 1074-1078
    CrossrefPubMedGoogle Scholar
  • 5 Ruetten S, Komp M, Merk H, Godolias G. Surgical treatment for lumbar lateral recess stenosis with the full-endoscopic interlaminar approach versus conventional microsurgical technique: a prospective, randomized, controlled study. J Neurosurg Spine 2009; 10 (05) 476-485
    CrossrefPubMedGoogle Scholar
  • 6 Choi KC, Kim JS, Ryu KS, Kang BU, Ahn Y, Lee SH. Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation: transforaminal versus interlaminar approach. Pain Physician 2013; 16 (06) 547-556
    PubMedGoogle Scholar
  • 7 Bender M, Gramsch C, Herrmann L. et al. Implementation of transforaminal endoscopic lumbar sequesterectomy on a German university hospital setting: a long and rocky road. J Neurol Surg A 2020; 81: 28-32
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Ahn Y, Kim CH, Lee JH, Lee SH, Kim JS. Radiation exposure to the surgeon during percutaneous endoscopic lumbar discectomy: a prospective study. Spine 2013; 38 (07) 617-625
    CrossrefPubMedGoogle Scholar
  • 9 Jones DP, Robertson PA, Lunt B, Jackson SA. Radiation exposure during fluoroscopically assisted pedicle screw insertion in the lumbar spine. Spine 2000; 25 (12) 1538-1541
    CrossrefPubMedGoogle Scholar
  • 10 Perisinakis K, Theocharopoulos N, Damilakis J. et al. Estimation of patient dose and associated radiogenic risks from fluoroscopically guided pedicle screw insertion. Spine 2004; 29 (14) 1555-1560
    CrossrefPubMedGoogle Scholar
  • 11 Dewey P, Incoll I. Evaluation of thyroid shields for reduction of radiation exposure to orthopaedic surgeons. Aust N Z J Surg 1998; 68 (09) 635-636
    CrossrefPubMedGoogle Scholar
  • 12 Hafez MA, Smith RM, Matthews SJ, Kalap G, Sherman KP. Radiation exposure to the hands of orthopaedic surgeons: are we underestimating the risk?. Arch Orthop Trauma Surg 2005; 125 (05) 330-335
    CrossrefPubMedGoogle Scholar
  • 13 Smith GL, Briggs TW, Lavy CB, Nordeen H. Ionising radiation: are orthopaedic surgeons at risk?. Ann R Coll Surg Engl 1992; 74 (05) 326-328
    PubMedGoogle Scholar
  • 14 Erken HY, Burc H, Saka G, Akmaz I, Aydogan M. Can radiation exposure to the surgeon be reduced with freehand pedicle screw fixation technique in pediatric spinal deformity correction? A prospective multicenter study. Spine 2014; 39 (06) 521-525
    CrossrefPubMedGoogle Scholar
  • 15 Bindal RK, Glaze S, Ognoskie M, Tunner V, Malone R, Ghosh S. Surgeon and patient radiation exposure in minimally invasive transforaminal lumbar interbody fusion. J Neurosurg Spine 2008; 9 (06) 570-573
    CrossrefPubMedGoogle Scholar
  • 16 Fitousi NT, Efstathopoulos EP, Delis HB, Kottou S, Kelekis AD, Panayiotakis GS. Patient and staff dosimetry in vertebroplasty. Spine 2006; 31 (23) E884-E889, E890
    CrossrefPubMedGoogle Scholar
  • 17 Harstall R, Heini PF, Mini RL, Orler R. Radiation exposure to the surgeon during fluoroscopically assisted percutaneous vertebroplasty: a prospective study. Spine 2005; 30 (16) 1893-1898
    CrossrefPubMedGoogle Scholar
  • 18 Kallmes DF, O E, Roy SS. et al. Radiation dose to the operator during vertebroplasty: prospective comparison of the use of 1-cc syringes versus an injection device. AJNR Am J Neuroradiol 2003; 24 (06) 1257-1260
    PubMedGoogle Scholar
  • 19 Kim CW, Lee YP, Taylor W, Oygar A, Kim WK. Use of navigation-assisted fluoroscopy to decrease radiation exposure during minimally invasive spine surgery. Spine J 2008; 8 (04) 584-590
    CrossrefPubMedGoogle Scholar
  • 20 Kruger R, Faciszewski T. Radiation dose reduction to medical staff during vertebroplasty: a review of techniques and methods to mitigate occupational dose. Spine 2003; 28 (14) 1608-1613
    CrossrefPubMedGoogle Scholar
  • 21 Mroz TE, Yamashita T, Davros WJ, Lieberman IH. Radiation exposure to the surgeon and the patient during kyphoplasty. J Spinal Disord Tech 2008; 21 (02) 96-100
    CrossrefPubMedGoogle Scholar
  • 22 Synowitz M, Kiwit J. Surgeon's radiation exposure during percutaneous vertebroplasty. J Neurosurg Spine 2006; 4 (02) 106-109
    CrossrefPubMedGoogle Scholar
  • 23 Yamashita K, Higashino K, Hayashi H, Hayashi F, Fukui Y, Sairyo K. Pulsation and collimation during fluoroscopy to decrease radiation: a cadaver study. JBJS Open Access 2017; 2 (04) e0039
    CrossrefPubMedGoogle Scholar
  • 24 Singer G. Occupational radiation exposure to the surgeon. J Am Acad Orthop Surg 2005; 13 (01) 69-76
    CrossrefPubMedGoogle Scholar
  • 25 Hendee WR. History, current status, and trends of radiation protection standards. Med Phys 1993; 20 (05) 1303-1314
    CrossrefPubMedGoogle Scholar
  • 26 Ul Haque M, Shufflebarger HL, O’Brien M. et al. Radiation exposure during pedicle screw placement in adolescent idiopathic scoliosis: is fluoroscopy safe?. Spine 2006; 31: 2516-2520
    CrossrefPubMedGoogle Scholar
  • 27 Mroz TE, Abdullah KG, Steinmetz MP, Klineberg EO, Lieberman IH. Radiation exposure to the surgeon during percutaneous pedicle screw placement. J Spinal Disord Tech 2011; 24 (04) 264-267
    CrossrefPubMedGoogle Scholar
  • 28 Qin H, Huang S, Xu L. et al. Radiation exposure and operation time in percutaneous endoscopic lumbar discectomy using fluoroscopy-based navigation system. World Neurosurg 2019; 127: e39-e48
    CrossrefPubMedGoogle Scholar
  • 29 Wei S, Tao W, Zhu H, Li Y. Three-dimensional intraoperative imaging with O-arm to establish a working trajectory in percutaneous endoscopic lumbar discectomy. Wideochir Inne Tech Malo Inwazyjne 2016; 10 (04) 555-560
    PubMedGoogle Scholar
  • 30 Chen X, Cheng J, Gu X, Sun Y, Politis C. Development of preoperative planning software for transforaminal endoscopic surgery and the guidance for clinical applications. Int J CARS 2016; 11 (04) 613-620
    CrossrefPubMedGoogle Scholar
  • 31 Zhao Y, Bo X, Wang C. et al. Guided punctures with ultrasound volume navigation in percutaneous transforaminal endoscopic discectomy: a technical note. World Neurosurg 2018; 119: 77-84
    CrossrefPubMedGoogle Scholar