Ishii Keisuske, Iwai Hiroki, Oka Hiroyuki, Otomo Katsutoshi, Inanami Hirohiko
Inanami Spine and Joint Hospital, Shinagawa-ku, Tokyo, Japan.
Teikyo University Hospital, Itabashi-Ku, Tokyo, Japan.
J Spine Surg. 2019 Dec;5(4):529-534. doi: 10.21037/jss.2019.09.17.
Endoscopic lumbar spine surgery is a minimally invasive technique that requires intraoperative fluoroscopic imaging. Fluoroscopy is a source of ionizing radiation, and exposure of the surgeon to this radiation has a risk for radiation-induced morbidities. To reduce this radiation exposure, we developed a protective method that can be used during endoscopic lumbar spine surgery. The purpose of the study was to determine the effectiveness of this method.
A prospective interventional study was performed, in which the primary outcome was radiation exposure to the surgeon [Sievert (Sv)] per case. This was measured using a radiation badge at the levels of the neck, chest, and abdomen on the surface of a protector for the surgeon in 18 endoscopic lumbar spine surgeries, including 9 each with the radiation protection method and the conventional method. Data were also collected for age, gender, body mass index, operative side, and total fluoroscopy time. Primary outcomes were compared in cases that used the radiation protection method and the conventional method.
The mean radiation exposures to the surgeon at the neck, chest, and abdomen were 1.0, 0.8 and 0.7 µSv, respectively, using the radiation protection method, and 3.2, 10.8, and 10.2 µSv, respectively, using the conventional method. The differences in exposure at all three points were significant (P=0.013, P<0.001, P<0.001, respectively).
These results show the effectiveness of the radiation protection method developed to reduce exposure of the surgeon to radiation during endoscopic lumbar spine surgery.
内镜下腰椎手术是一种需要术中透视成像的微创技术。透视是电离辐射的一个来源，外科医生暴露于这种辐射下有发生辐射诱发疾病的风险。为减少这种辐射暴露，我们开发了一种可在内镜下腰椎手术中使用的防护方法。本研究的目的是确定该方法的有效性。
进行了一项前瞻性干预研究，主要结局是每例手术外科医生的辐射暴露量[希沃特（Sv）]。在18例内镜下腰椎手术中，通过佩戴在外科医生防护装置表面的颈部、胸部和腹部水平的辐射剂量计来测量，其中9例采用辐射防护方法，9例采用传统方法。还收集了年龄、性别、体重指数、手术侧和总透视时间的数据。对采用辐射防护方法和传统方法的病例的主要结局进行比较。
采用辐射防护方法时，外科医生颈部、胸部和腹部的平均辐射暴露量分别为1.0、0.8和0.7微希沃特，而采用传统方法时分别为3.2、10.8和10.2微希沃特。所有三个部位的暴露差异均具有统计学意义（分别为P = 0.013、P < 0.001、P < 0.001）。
这些结果表明，所开发的辐射防护方法在减少内镜下腰椎手术中外科医生的辐射暴露方面是有效的。
