Medical university of Varna, ul. "Professor Marin Drinov" 55, 9002 Center Varna, Bulgaria.
Medical university of Varna, ul. "Professor Marin Drinov" 55, 9002 Center Varna, Bulgaria.
Orthop Traumatol Surg Res. 2021 Nov;107(7):102795. doi: 10.1016/j.otsr.2020.102795. Epub 2020 Dec 14.
Intraoperative imaging in minimally invasive spinal surgeries is associated with significant radiation exposure to surgeons, which overtime can lead to serious health hazards including malignancy. In this study, the authors conducted a systematic review to evaluate the efficacy of navigation assisted fluoroscopy methods on radiation exposure to the surgeon in minimally invasive spine surgeries, percutaneous endoscopic lumbar discectomy/percutaneous endoscopic transforaminal discectomy versus minimally invasive spine transforaminal lumbar interbody fusion (PELD/PETD versus MIS-TLIF).
A systematic literature search was conducted using PUBMED/MEDLINE on 20th July, 2020. Inclusion criteria were applied according to study design, surgical technique, spinal region, and language. Data extracted included lumbar segment, average operation time (min), fluoroscopic time (s), and radiation dose (μSV), efficacy of modified navigation versus conventional techniques; on reducing operation, fluoroscopy times and effective radiation dose.
Fifteen studies (ten prospectives, and five retrospectives) were included for quantitative analysis. PELD recorded a shorter operation time (by 126.3min, p<0.001) and fluoroscopic time (by 22.9s, p=0.3) than MIS-TLIF. The highest radiation dose/case (μSV) for both techniques were recorded at the surgeon's: finger, chest, neck and eye. The effective dose for MIS-TLIF was 30μSV higher than PELD. Modified navigation techniques recorded a shorter operation time (by 15.9min, p=0.3); fluoroscopy time (by 289.8s, p=0.3); effective radiation dose (by 169.5μSV, p=0.3) than conventional fluoroscopy methods.
This systematic literature review showed that although navigation assisted fluoroscopy techniques are superior to conventional methods in minimising radiation exposure, lack of statistical significance warrants future randomised controlled trials, to solidify their efficacy in reducing radiation related hazards.
微创脊柱手术中的术中成像会使外科医生受到大量辐射，随着时间的推移，这可能会导致严重的健康危害，包括恶性肿瘤。在这项研究中，作者进行了一项系统评价，以评估导航辅助透视方法在微创脊柱手术中对外科医生辐射暴露的效果，经皮内窥镜腰椎间盘切除术/经皮内窥镜经椎间孔椎间盘切除术与微创经椎间孔腰椎椎间融合术（PELD/PETD 与 MIS-TLIF）。
2020 年 7 月 20 日，通过 PUBMED/MEDLINE 进行系统文献检索。根据研究设计、手术技术、脊柱区域和语言应用纳入标准。提取的数据包括腰椎节段、平均手术时间（分钟）、透视时间（秒）和辐射剂量（μSV）、改良导航与常规技术的效果；减少手术、透视时间和有效辐射剂量。
纳入了 15 项研究（10 项前瞻性研究和 5 项回顾性研究）进行定量分析。PELD 记录的手术时间（缩短 126.3 分钟，p<0.001）和透视时间（缩短 22.9 秒，p=0.3）均短于 MIS-TLIF。两种技术的外科医生手指、胸部、颈部和眼睛的最高辐射剂量/病例（μSV）。MIS-TLIF 的有效剂量比 PELD 高 30μSV。改良导航技术记录的手术时间（缩短 15.9 分钟，p=0.3）；透视时间（缩短 289.8 秒，p=0.3）；有效辐射剂量（缩短 169.5μSV，p=0.3）均短于常规透视方法。
这项系统文献综述表明，尽管导航辅助透视技术在减少辐射暴露方面优于常规方法，但缺乏统计学意义需要未来的随机对照试验来证实其在减少辐射相关危害方面的效果。
