Can intraoperative radiation dose in percutaneous posterior thoracolumbar internal fixation be reduced by impedancemetry-guided pedicle sighting? A prospective randomized study.

INTRODUCTION

Percutaneous spine surgery is on the rise; the main drawback is iterative irradiation of the care team in theater. The aim of the present study was to compare intraoperative radiation dose in percutaneous posterior thoracolumbar internal fixation (PPTLIF) using impedancemetry-guided pedicle sighting by the PediGuard device (SpineGuard®) versus gold-standard free-hand sighting.

MATERIAL AND METHODS

A single-center, single-surgeon continuous prospective randomized study was conducted from September 2017 to April 2018. Dose-area product (DAP, in cGy.cm) was recorded at the end of pedicle sighting and end of surgery in the free-hand control group and the impedancemetry group. Pedicle screw position was studied on postoperative CT scan.

RESULTS

Sixteen patients were included in either group after 2 had been excluded. The groups were comparable for age, gender, body-mass index (BMI), indication and number of instrumented levels. Mean DPA at end of sighting and end of procedure was respectively 147.4 cGy.cm and 230.9 cGy.cm in the control group and 171.1 cGy.cm and 280.7 cGy.cm in the PediGuard group (p> 0.05). Screw positioning on CT was comparable in the 2 groups.

CONCLUSION

In the present study, the PediGuard device did not reduce intraoperative radiation dose. The correlation between radiation dose and BMI was confirmed.

LEVEL OF EVIDENCE

II; prospective randomized study.