Radiation Exposure and Avoidance in Minimally Invasive Spine Surgery
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.
KeywordsIonizing radiation Minimally invasive spine surgery MIS surgery Radiation exposure
- 6.United States Nuclear Regulatory Commission website. https://www.nrc.gov/about-nrc/radiation/around-us/doses-daily-lives.html.
- 7.National Council on Radiation Protection & Measurements. Recommendation on limits for exposure of Ionizing radiation. Bethesda: National Council on Radiation Protection & Measurements; 1987. Report No. 91.Google Scholar
- 11.Kruger R, Faciszewski T. Radiation dose reduction to medical staff during vertebroplasty: a review of techniques and methods to mitigate occupational dose. Spine (Phila Pa 1976). 2003;28:1608–13.Google Scholar
- 15.Bronsard N, Boli T, Challali M, de Dompsure R, Amoretti N, Padovani B, Bruneton G, Fuchs A, de Peretti F. Comparison between percutaneous and traditional fixation of lumbar spine fracture: intraoperative radiation exposure levels and outcomes. Orthop Traumatol Surg Res. 2013;99(2):162–8.CrossRefGoogle Scholar
- 18.Taher F, Hughes AP, Sama AA, Zeldin R, Schneider R, Holodny EI, Lebl DR, Fantini GA, Nguyen J, Cammisa FP, Girardi FP. 2013 Young Investigator Award winner: how safe is lateral lumbar interbody fusion for the surgeon? A prospective in vivo radiation exposure study. Spine (Phila Pa 1976). 2013;38:1386–92.CrossRefGoogle Scholar
- 19.The 2007 recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP. 2007;37(2–4):1–332.Google Scholar
- 24.Heggie JC, Liddell NA, Maher KP. Applied imaging technology. Melbourne: St. Vincent’s Hospital; 2001.Google Scholar
- 26.Taher F, Hughes AP, Sama AA, Zeldin R, Schneider R, Holodny EI, Lebl DR, Fantini GA, Nguyen J, Cammisa FP, Girardi FP. 2013 Young Investigator Award winner: how safe is lateral lumbar interbody fusion for the surgeon? A prospective in vivo radiation exposure study. Spine. 2013;38(16):1386–92.CrossRefGoogle Scholar