Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA.
Neurosurg Focus. 2013 Aug;35(2):E8. doi: 10.3171/2013.5.FOCUS13144.
There is an increasing awareness of radiation exposure to surgeons and the lifelong implications of such exposure. One of the main criticisms of minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) is the amount of ionizing radiation required to perform the procedure. The goal in this study was to develop a protocol that would minimize the fluoroscopy time and radiation exposure needed to perform an MIS TLIF without compromising visualization of the anatomy or efficiency of the procedure.
A retrospective review of a prospectively collected database was performed to review the development of a low-dose protocol for MIS TLIFs in which a combination of low-dose pulsed fluoroscopy and digital spot images was used. Total fluoroscopy time and radiation dose were reviewed for 50 patients who underwent single-level MIS TLIFs.
Fifty patients underwent single-level MIS TLIFs, resulting in the placement of 200 pedicle screws and 57 interbody spacers. There were 28 women and 22 men with an average age of 58.3 years (range 32-78 years). The mean body mass index was 26.2 kg/m(2) (range 17.1-37.6 kg/m(2)). Indications for surgery included spondylolisthesis (32 patients), degenerative disc disease with radiculopathy (12 patients), and recurrent disc herniation (6 patients). Operative levels included 7 at L3-4, 40 at L4-5, and 3 at L5-S1. The mean operative time was 177 minutes (range 139-241 minutes). The mean fluoroscopic time was 18.72 seconds (range 7-29 seconds). The mean radiation dose was 0.247 mGym(2) (range 0.06046-0.84054 mGym(2)). No revision surgery was required for any of the patients in this series.
Altering the fluoroscopic technique to low-dose pulse images or digital spot images can dramatically decrease fluoroscopy times and radiation doses in patients undergoing MIS TLIFs, without compromising image quality, accuracy of pedicle screw placement, or efficiency of the procedure.
人们越来越意识到外科医生接受的辐射暴露及其带来的终身影响。微创经椎间孔腰椎体间融合术（MIS TLIF）的主要批评之一是进行该手术所需的电离辐射量。本研究的目的是制定一种方案，在不影响解剖结构可视化或手术效率的情况下，尽量减少进行 MIS TLIF 所需的透视时间和辐射暴露。
对前瞻性收集的数据库进行回顾性研究，以回顾用于 MIS TLIF 的低剂量方案的开发情况，该方案结合了低剂量脉冲透视和数字点片成像。对 50 例接受单节段 MIS TLIF 的患者的总透视时间和辐射剂量进行了回顾。
50 例患者接受了单节段 MIS TLIF，共放置了 200 枚椎弓根螺钉和 57 枚椎间融合器。患者中有 28 名女性和 22 名男性，平均年龄为 58.3 岁（范围 32-78 岁）。平均体重指数为 26.2kg/m2（范围 17.1-37.6kg/m2）。手术指征包括脊椎滑脱（32 例）、神经根病变伴退行性椎间盘疾病（12 例）和复发性椎间盘突出症（6 例）。手术节段包括 L3-4 节段 7 个，L4-5 节段 40 个，L5-S1 节段 3 个。平均手术时间为 177 分钟（范围 139-241 分钟）。平均透视时间为 18.72 秒（范围 7-29 秒）。平均辐射剂量为 0.247mGym2（范围 0.06046-0.84054mGym2）。本系列患者中无一例需要翻修手术。
改变透视技术为低剂量脉冲图像或数字点片图像可以显著减少接受 MIS TLIF 的患者的透视时间和辐射剂量，而不影响图像质量、椎弓根螺钉放置的准确性或手术效率。
