Minimising radiation exposure to the surgeon in minimally invasive spine surgeries: A systematic review of 15 studies

Background: 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). Methods: 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 (mu SV), efficacy of modified navigation versus conventional techniques; on reducing operation, fluoroscopy times and effective radiation dose. Results: Fifteen studies (ten prospectives, and five retrospectives) were included for quantitative analysis. PELD recorded a shorter operation time (by 126.3 min, p < 0.001) and fluoroscopic time (by 22.9 s, p = 0.3) than MIS-TLIF. The highest radiation dose/case ( mu SV) for both techniques were recorded at the surgeon's: finger, chest, neck and eye. The effective dose for MIS-TLIF was 30 mu SV higher than PELD. Modified navigation techniques recorded a shorter operation time (by 15.9 min, p = 0.3); fluoroscopy time (by 289.8 s, p = 0.3); effective radiation dose (by 169.5 mu SV, p = 0.3) than conventional fluoroscopy methods. Discussion: 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. (C) 2020 Elsevier Masson SAS. All rights reserved.

Automated summary

This systematic review evaluated the efficacy of navigation assisted fluoroscopy methods in minimizing radiation exposure to surgeons during minimally invasive spine surgeries. The results showed that modified navigation techniques can significantly reduce operation time, fluoroscopic time, and effective radiation dose compared to conventional methods. However, future randomized controlled trials are needed to strengthen the evidence of their efficacy in reducing radiation-related hazards, as the lack of statistical significance was noted.