Mendelsohn Daniel, Strelzow Jason, Dea Nicolas, Ford Nancy L, Batke Juliet, Pennington Andrew, Yang Kaiyun, Ailon Tamir, Boyd Michael, Dvorak Marcel, Kwon Brian, Paquette Scott, Fisher Charles, Street John
Combined Neurosurgical and Orthopedic Spine Program, Vancouver General Hospital, Departments of Orthopedics and Neurosurgery, University of British Columbia, Vancouver, Canada; Faculty of Dentistry, Department of Oral Biological and Medical Sciences, University of British Columbia, Vancouver, Canada.
Combined Neurosurgical and Orthopedic Spine Program, Vancouver General Hospital, Departments of Orthopedics and Neurosurgery, University of British Columbia, Vancouver, Canada.
Spine J. 2016 Mar;16(3):343-54. doi: 10.1016/j.spinee.2015.11.020. Epub 2015 Dec 10.
Imaging modalities used to visualize spinal anatomy intraoperatively include X-ray studies, fluoroscopy, and computed tomography (CT). All of these emit ionizing radiation.
Radiation emitted to the patient and the surgical team when performing surgeries using intraoperative CT-based spine navigation was compared.
STUDY DESIGN/SETTING: This is a retrospective cohort case-control study.
Seventy-three patients underwent CT-navigated spinal instrumentation and 73 matched controls underwent spinal instrumentation with conventional fluoroscopy.
Effective doses of radiation to the patient when the surgical team was inside and outside of the room were analyzed. The number of postoperative imaging investigations between navigated and non-navigated cases was compared.
Intraoperative X-ray imaging, fluoroscopy, and CT dosages were recorded and standardized to effective doses. The number of postoperative imaging investigations was compared with the matched cohort of surgical cases. A literature review identified historical radiation exposure values for fluoroscopic-guided spinal instrumentation.
The 73 navigated operations involved an average of 5.44 levels of instrumentation. Thoracic and lumbar instrumentations had higher radiation emission from all modalities (CT, X-ray imaging, and fluoroscopy) compared with cervical cases (6.93 millisievert [mSv] vs. 2.34 mSv). Major deformity and degenerative cases involved more radiation emission than trauma or oncology cases (7.05 mSv vs. 4.20 mSv). On average, the total radiation dose to the patient was 8.7 times more than the radiation emitted when the surgical team was inside the operating room. Total radiation exposure to the patient was 2.77 times the values reported in the literature for thoracolumbar instrumentations performed without navigation. In comparison, the radiation emitted to the patient when the surgical team was inside the operating room was 2.50 lower than non-navigated thoracolumbar instrumentations. The average total radiation exposure to the patient was 5.69 mSv, a value less than a single routine lumbar CT scan (7.5 mSv). The average radiation exposure to the patient in the present study was approximately one quarter the recommended annual occupational radiation exposure. Navigation did not reduce the number of postoperative X-rays or CT scans obtained.
Intraoperative CT navigation increases the radiation exposure to the patient and reduces the radiation exposure to the surgeon when compared with values reported in the literature. Intraoperative CT navigation improves the accuracy of spine instrumentation with acceptable patient radiation exposure and reduced surgical team exposure. Surgeons should be aware of the implications of radiation exposure to both the patient and the surgical team when using intraoperative CT navigation.
用于术中可视化脊柱解剖结构的成像方式包括X线检查、荧光透视和计算机断层扫描（CT）。所有这些都会发出电离辐射。
比较使用基于术中CT的脊柱导航进行手术时患者和手术团队所接受的辐射。
研究设计/设置：这是一项回顾性队列病例对照研究。
73例患者接受了CT导航下的脊柱内固定术，73例匹配的对照组患者接受了传统荧光透视引导下的脊柱内固定术。
分析手术团队在手术室内外时患者所接受的有效辐射剂量。比较导航组和非导航组术后影像学检查的次数。
记录术中X线成像、荧光透视和CT剂量，并将其标准化为有效剂量。将术后影像学检查次数与匹配的手术病例队列进行比较。文献综述确定了荧光透视引导下脊柱内固定术的历史辐射暴露值。
73例导航手术平均涉及5.44个节段的内固定。与颈椎手术相比，胸椎和腰椎手术在所有成像方式（CT、X线成像和荧光透视）下的辐射发射更高（6.93毫希沃特[mSv]对2.34 mSv）。严重畸形和退行性病例的辐射发射比创伤或肿瘤病例更多（7.05 mSv对4.20 mSv）。平均而言，患者接受的总辐射剂量比手术团队在手术室内时所接受的辐射剂量高8.7倍。患者的总辐射暴露是文献报道的非导航下胸腰椎内固定术辐射值的2.77倍。相比之下，手术团队在手术室内时患者所接受的辐射比非导航下胸腰椎内固定术低2.50倍。患者的平均总辐射暴露为5.69 mSv，低于单次常规腰椎CT扫描（7.5 mSv）。本研究中患者的平均辐射暴露约为推荐的年度职业辐射暴露的四分之一。导航并未减少术后获得的X线或CT扫描次数。
与文献报道的值相比，术中CT导航增加了患者的辐射暴露，减少了外科医生的辐射暴露。术中CT导航提高了脊柱内固定的准确性，患者辐射暴露可接受，手术团队暴露减少。外科医生在使用术中CT导航时应意识到辐射对患者和手术团队的影响。
