Assessment of the surgeon radiation exposure during a minimally invasive TLIF: Comparison between fluoroscopy and O-arm system

Introduction. - Transforaminal lumbar interbody fusion with a minimally invasive approach (MIS TLIF) has become a very popular technique in the treatment of degenerative diseases of the lumbar spine, as it allows a decrease in muscle iatrogenic. However, iterative radiological controls inherent to this technique are responsible for a significant increase in exposure to ionizing radiation for the surgeon. New techniques for radiological guidance (O-arm navigation-assisted) would overcome this drawback, but this remains unproven. Objectives. - To analyze the exposure of the surgeon to intraoperative X-ray during a MIS TLIF under fluoroscopy and under O-arm navigation-assisted. Materials and methods. - This prospective study was conducted at the University Hospital of Lille from February to May 2013. Twelve patients underwent a MIS TLIF for the treatment of low-grade spondylolisthesis; six under standard fluoroscopy (group 1) and six under O-arm system (group 2). Passive dosimeters (rings and glasses) and active dosimeters for thorax were used to measure the radiation exposure of the surgeon. Results. - For group 1, the average time of fluoroscopy was 3.718 minutes (3.13-4.56) while no radioscopy was perform on group 2. For the first group, the average exposure dose was 12 mu Sv (5-20 mu Sv) on the thorax, 1168 mu Sv (510-2790 mu Sv) on the main hand and 179 mu Sv (103-486 mu Sv) on the lens. The exposure dose was measured zero on the second group. Conclusion. - The maximum recommended doses can be reached, mainly for the lens. In addition to the radioprotection measures, O-arm navigation systems are safe alternatives to significantly reduce surgeon exposure. (C) 2015 Elsevier Masson SAS. All rights reserved.