Ionizing radiation

Ionizing radiation is typically used during spine surgery for localization and guidance in instrumentation placement.

Minimally invasive (MI) surgical procedures are increasingly popular often require significantly more fluoroscopy, placing surgeons at risk for increased radiation exposure and radiation-induced complications.

PubMed database was queried for relevant articles pertaining to radiation exposure in spine surgery.

Discectomy, Percutaneous Pedicle screw fixation, MI transforaminal lumbar inter body fusion (TLIF), MI lateral lumbar inter body fusion, andvertebroplasty/kyphoplasty procedures were assessed. The highest radiation doses were seen with MI pedicle screw placement, MI TLIF, vertebroplasty/kyphoplasty, and percutaneous endoscopic lumbar discectomy. Use of lead aprons and thyroid shields reduces effective dose by several orders of magnitude. Proper operator positioning also minimizes radiation exposure. Lead gloves decrease dose to the surgeon’s hand from scatter if the hand is out of the x-ray beam the majority of the time. If prolonged exposure of the hand cannot be avoided, the technician should collimate the surgeon’s hand out of the beam or use instruments to position the hand farther from the beam. In addition to using less fluoroscopy, pulsed fluoroscopy can also decrease overall dose in a procedure.

Spine surgeons should reduce radiation exposure to minimize risk of potential long-term complications. Strategies include minimizing fluoroscopy use and dose, proper use of protective gear, and appropriate manipulation of fluoroscopic equipment 1).

1) Srinivasan D, Than KD, Wang AC, La Marca F, Wang PI, Schermerhorn TC, Park P. Radiation Safety and Spine Surgery: Systematic Review of Exposure Limits and Methods to Minimize Radiation Exposure. World Neurosurg. 2014 Jul 31. pii: S1878-8750(14)00701-3. doi: 10.1016/j.wneu.2014.07.041. [Epub ahead of print] Review. PubMed PMID: 25088230.

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