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Radiation Exposure and Avoidance in Minimally Invasive Spine Surgery

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Minimally Invasive Spine Surgery

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Abstract

The advent of minimally invasive spine surgery (MIS or MISS) heralds an important milestone in the surgical management of spinal disorders. MIS provides the modern spine surgeon the ability to treat spine pathology in a precise, less morbid manner when compared to open procedures. The benefits of MIS over open procedures include, but are not limited to, decreased blood loss, decreased infection rates, and decreased hospital length of stay. These benefits of MIS coexist with the burden of an increased reliance on radiographic imaging in the operating theater. Radiography in MIS can produce significant amounts of radiation, placing both the surgeon and patient at risk. Efforts to limit radiation exposure in MIS stem from a basic understanding of the physical nature of ionizing radiation and its effects on living tissue. Although the quantity of radiation produced in various MIS procedures varies in the literature, a surgeon’s hands and thyroid gland may represent structures consistently at risk. Techniques to limit radiation exposure include preoperative considerations, such as prudently planning when imaging is necessary during a case, and intraoperative adjustments such as appropriately positioning the radiation source in relation to the patient and surgeon. Knowledge of these techniques allows spine surgeons to effectively perform MIS while simultaneously reducing radiation exposure.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, USA

    Bryan S. Lee

  2. Center for Spine Health, Cleveland Clinic, Cleveland, OH, USA

    Bryan S. Lee

  3. Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA

    Bryan S. Lee

  4. Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, USA

    Dominic W. Pelle

  5. Center for Spine Health, Cleveland Clinic, Cleveland, OH, USA

    Dominic W. Pelle

  6. Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA

    Nicholas R. Arnold

  7. Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, USA

    Thomas E. Mroz

  8. Center for Spine Health, Cleveland Clinic, Cleveland, OH, USA

    Thomas E. Mroz

  9. Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA

    Thomas E. Mroz

Authors
  1. Bryan S. Lee
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  2. Dominic W. Pelle
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  3. Nicholas R. Arnold
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  4. Thomas E. Mroz
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Corresponding author

Correspondence to Thomas E. Mroz .

Editor information

Editors and Affiliations

  1. Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA

    Frank M. Phillips

  2. Texas Back Institute Texas Health Presbyterian Hospital Plano Scoliosis and Spine Tumor Center, Plano, TX, USA

    Isador H. Lieberman

  3. Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA

    David W. Polly Jr.

  4. Department of Neurological Surgery, University of Miami/Jackson Memorial Hospital, Miami, FL, USA

    Michael Y. Wang

Appendices

Quiz Questions

  1. 1.

    All of the following are reported benefits of MIS, except?

    1. (a)

      Decreased length of stay following surgery

    2. (b)

      Decreased operative time

    3. (c)

      Decreased blood loss in the operating room

    4. (d)

      Lowered overall cost to the health-care system

  2. 2.

    The ratio of background (or natural) to artificial (or manmade) radiation the average American citizen receives in a year is closest to:

    1. (a)

      1:1

    2. (b)

      4:1

    3. (c)

      3:1

    4. (d)

      2:1

  3. 3.

    The ALARA principle stands for?

    1. (a)

      As Low As Radiation Allowed

    2. (b)

      As Limited As Radiation Allowed

    3. (c)

      As Low As Reasonably Achievable

    4. (d)

      As Limited As Research Advocates

  4. 4.

    Collimation refers to which technique of altering radiation exposure?

    1. (a)

      The field of view is narrowed to capture only what is necessary when obtaining a fluoroscopic radiograph.

    2. (b)

      The XR beams from the image source are emitted in a parallel fashion.

    3. (c)

      The amount of radiation from the image source is increased.

    4. (d)

      The radiograph display is split into a series of columns for further visualization.

  5. 5.

    When a surgeon doubles their distance from a radiation source, their radiation exposure is altered by what proportion?

    1. (a)

      2

    2. (b)

      1

    3. (c)

      ¼

    4. (d)

      ½

Answers

  1. 1.

    b

  2. 2.

    a

  3. 3.

    c

  4. 4.

    a

  5. 5.

    c

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Lee, B.S., Pelle, D.W., Arnold, N.R., Mroz, T.E. (2019). Radiation Exposure and Avoidance in Minimally Invasive Spine Surgery. In: Phillips, F., Lieberman, I., Polly Jr., D., Wang, M. (eds) Minimally Invasive Spine Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-19007-1_13

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  • DOI: https://doi.org/10.1007/978-3-030-19007-1_13

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-19006-4

  • Online ISBN: 978-3-030-19007-1

  • eBook Packages: MedicineMedicine (R0)

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