title: Comparison of radiation exposure in lumbar pedicle screw placement with fluoroscopy vs computer-assisted image guidance with intraoperative three-dimensional imaging.
abstract: OBJECTIVE
  Little is known about the long-term effects of chronic exposure to ionizing radiation. Studies have shown that spine surgeons may be exposed to significantly more radiation than that observed in surgery on the appendicular skeleton. Computer-assisted image guidance systems have been shown in preliminary studies to enable accurate instrumentation of the spine. Computer-assisted image guidance systems may have significant application to the surgical management of spinal trauma and deformity. The objective of this study was to compare C-arm fluoroscopy and computer-assisted image guidance in terms of radiation exposure to the operative surgeon when placing pedicle screw-rod constructs in cadaver specimens.
  
  
  METHODS
  Twelve single-level (2 contiguous vertebral bodies) lumbar pedicle screw-rod constructs (48 screws) in 4 fresh cadavers were placed using standard C-arm fluoroscopy and computer-assisted image guidance (Stealth Station with Iso-C(3D)). Pedicle screw-rod constructs were placed at L1-L2, L3-L4, and L5-S1 in 4 fresh cadaver specimens. Imaging was alternated between C-arm fluoroscopy and computer-assisted image guidance with StealthStation Iso-C(3D). Radiation exposure was measured using ring and badge dosimeters to monitor the thyroid, torso, and index finger. Postprocedure CT scans were obtained to judge accuracy of screw placement.
  
  
  RESULTS
  Mean radiation exposure to the torso was 4.33 +/- 2.66 mRem for procedures performed with standard fluoroscopy and 0.33 +/- 0.82 mRem for procedures performed with computer-assisted image guidance. This difference was statistically significant (P= 0.012). Radiation exposure to the index finger and thyroid was negligible for all procedures. The accuracy of screw placement was similar for both techniques.
  
  
  CONCLUSIONS
  Computer-assisted image guidance systems allow for the safe and accurate placement of pedicle screw-rod constructs with a significant reduction in exposure to ionizing radiation to the torso of the operating surgeon.
authors.affiliation: Thomas Jefferson University, Department of Orthopaedic Surgery, Philadelphia, PA 19107, USA. harveysmith27@gmail.com
authors.forename: Harvey E
authors.initials: HE
authors.lastname: Smith
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Welsch
authors.forename: Rick C
authors.initials: RC
authors.lastname: Sasso
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws; D002102:Cadaver; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008875:Middle Aged; D011827:Radiation; D013123:Spinal Fusion / Q000379:methods; D025321:Surgery, Computer-Assisted / Q000379:methods*