Bindal Rajesh K, Glaze Sharon, Ognoskie Meghann, Tunner Van, Malone Robert, Ghosh Subrata
Section of Neurosurgery, Methodist Sugar Land Hospital, Sugar Land, Texas, USA.
J Neurosurg Spine. 2008 Dec;9(6):570-3. doi: 10.3171/SPI.2008.4.08182.
Minimally invasive transforaminal lumbar interbody fusion (TLIF) is an increasingly popular procedure. The technique involves use of fluoroscopy to assist with pedicle screw (PS) placement. The potential exists for both the surgeon and the patient to become exposed to significant amounts of radiation. The authors undertook this study to quantify the radiation dose to the surgeon and patient during minimally invasive TLIF.
The authors undertook a prospective study of 24 consecutive patients who underwent minimally invasive TLIF. All surgeries were performed by the senior author (R.K.B.), who used techniques previously described. The surgeon wore a radiation monitor under an apron-style lead shield at waist level, at an unshielded collar location, and as a sterile ring badge containing a thermoluminescent dosimeter on the dominant (right) hand ring finger. Dosimeter readings were obtained for each case. A total of 33 spinal levels were treated in 24 patients. All treated levels were between L3-4 and L5-S1. In all cases of 1-level disease, 4 PSs were placed, and in all cases of 2-level disease, 6 screws were placed.
Mean fluoroscopy time was 1.69 minutes per case (range 3.73-0.82 minutes). Mean exposure per case to the surgeon on his dominant hand was 76 mRem, at the waist under a lead apron was 27 mRem, and at an unprotected thyroid level was 32 mRem. Mean exposure to the patient's skin was 59.5 mGy (range 8.3-252 mGy) in the posteroanterior plane and 78.8 mGy (range 6.3-269.5 mGy) in the lateral plane.
To the authors' knowledge, this is the first study of radiation exposure to the surgeon or patient in minimally invasive TLIF. Patient exposures were low and compare favorably with exposures involving other common interventional fluoroscopically guided procedures. Surgeon exposures are limited but require careful monitoring. Annual dose limits could be exceeded if a large number of these and other fluoroscopically guided procedures were performed.
微创经椎间孔腰椎椎间融合术（TLIF）是一种越来越受欢迎的手术。该技术涉及使用荧光透视来辅助椎弓根螺钉（PS）置入。外科医生和患者都有可能受到大量辐射。作者进行这项研究以量化微创TLIF过程中外科医生和患者所接受的辐射剂量。
作者对24例连续接受微创TLIF的患者进行了前瞻性研究。所有手术均由资深作者（R.K.B.）进行，其采用了先前描述的技术。外科医生在腰部水平的围裙式铅屏蔽下、未屏蔽的领口位置以及作为包含热释光剂量计的无菌指环佩戴在优势（右）手无名指上佩戴辐射监测器。获取每个病例的剂量计读数。24例患者共治疗了33个脊柱节段。所有治疗节段均在L3 - 4和L5 - S1之间。在所有单节段疾病病例中，置入4枚PS，在所有双节段疾病病例中，置入6枚螺钉。
平均每例荧光透视时间为1.69分钟（范围3.73 - 0.82分钟）。外科医生优势手每例平均暴露剂量为76毫雷姆，腰部在铅围裙下为27毫雷姆，未受保护的甲状腺水平为32毫雷姆。患者皮肤在后前位平面的平均暴露剂量为59.5毫戈瑞（范围8.3 - 252毫戈瑞），在侧位平面为78.8毫戈瑞（范围6.3 - 269.5毫戈瑞）。
据作者所知，这是首次关于微创TLIF中外科医生或患者辐射暴露的研究。患者暴露剂量较低，与其他常见的荧光透视引导介入手术的暴露剂量相比具有优势。外科医生的暴露剂量有限，但需要仔细监测。如果进行大量此类及其他荧光透视引导手术，可能会超过年度剂量限制。
