Radiation safety and spine surgery

Systematic review of exposure limits and methods to minimize radiation exposure

Dushyanth Srinivasan, Khoi Than, Anthony C. Wang, Frank La Marca, Page I. Wang, Thomas C. Schermerhorn, Paul Park

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Background Ionizing radiation is typically used during spine surgery for localization and guidance in instrumentation placement. Minimally invasive (MI) surgical procedures are increasingly popular and often require significantly more fluoroscopy, placing surgeons at risk for increased radiation exposure and radiation-induced complications. This study provides recommendations for minimizing risk of radiation-induced injury to spine surgeons and summarizes studies addressing radiation exposure in spine procedures.

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

Results Discectomy, percutaneous pedicle screw placement, MI transforaminal lumbar interbody fusion, MI lateral lumbar interbody fusion, and vertebroplasty/kyphoplasty procedures were assessed. The highest radiation doses were seen with MI pedicle screw placement, MI transforaminal lumbar interbody fusion, vertebroplasty and 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 most 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 decrease overall dose in a procedure.

Conclusions Spine surgeons should reduce their exposure to radiation 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.

Original languageEnglish (US)
Pages (from-to)1337-1343
Number of pages7
JournalWorld Neurosurgery
Volume82
Issue number6
DOIs
StatePublished - Dec 1 2014
Externally publishedYes

Fingerprint

Fluoroscopy
Spine
Hand
Radiation
Safety
Kyphoplasty
Vertebroplasty
Percutaneous Diskectomy
Background Radiation
Diskectomy
Radiation Injuries
Minimally Invasive Surgical Procedures
Ionizing Radiation
PubMed
Thyroid Gland
X-Rays
Surgeons
Radiation Exposure
Databases
Equipment and Supplies

Keywords

  • Fusion
  • Minimally invasive
  • Radiation
  • Safety
  • Spine

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Medicine(all)

Cite this

Radiation safety and spine surgery : Systematic review of exposure limits and methods to minimize radiation exposure. / Srinivasan, Dushyanth; Than, Khoi; Wang, Anthony C.; La Marca, Frank; Wang, Page I.; Schermerhorn, Thomas C.; Park, Paul.

In: World Neurosurgery, Vol. 82, No. 6, 01.12.2014, p. 1337-1343.

Research output: Contribution to journalArticle

Srinivasan, Dushyanth ; Than, Khoi ; Wang, Anthony C. ; La Marca, Frank ; Wang, Page I. ; Schermerhorn, Thomas C. ; Park, Paul. / Radiation safety and spine surgery : Systematic review of exposure limits and methods to minimize radiation exposure. In: World Neurosurgery. 2014 ; Vol. 82, No. 6. pp. 1337-1343.
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