title: Computer navigation in balloon kyphoplasty reduces the intraoperative radiation exposure.
abstract: METHODS
  Comparison of the dose area product (DAP), the radiation time and the operation time during computer navigated and conventional balloon kyphoplasty procedures.
  
  
  OBJECTIVE
  To compare the patients radiation exposure and operation time in a balloon kyphoplasty procedure with and without using a navigation system for the placement of working needles.
  
  
  BACKGROUND
  Minimal invasive spine surgery is associated with high radiation exposure for both the patient and the surgeon. The use of computer navigation has led to a reduced radiation exposure in experimental trials. To our knowledge, there is no clinical data determining the influence of computer navigation on radiation exposure and operation time in a balloon kyphoplasty procedure.
  
  
  METHODS
  Twenty-nine patients with 30 osteoporotic vertebra fractures were treated with a computer-navigated kyphoplasty. The placement of the working needles in thoracic spine fractures was performed after acquiring an intraoperative three-dimensional data set. Fractures of the lumbar spine were treated using fluoroscopic three-dimensional navigation. During each procedure the operation time, the overall radiation time, and the DAP were documented. The data of the navigated operations were compared to a control group of consisting of 30 conventional balloon kyphoplasty procedures.
  
  
  RESULTS
  In the conventional kyphoplasty group the average operation times for thoracic spine (ts) and lumbar spine (ls) were 61 and 57 minutes, respectively. The average radiation times were 175 and 165 seconds. The DAP applied to the patient was 1972 and 2105 cGy cm. The average operation times in the navigated group were 67 minutes in the ts and 62 minutes in the ls. The average radiation time was reduced significantly in the navigated group (99 seconds ts and 74 seconds ls). The DAP applied to the patient was also significantly lower (1245 cGy cm (ts) and 1318 cGy cm (ls)).
  
  
  CONCLUSIONS
  The use of computer navigation systems in balloon kyphoplasty procedures reduces the radiation exposure of patients and surgeons significantly. The increased technical effort did not lead to a significant longer operation time. Hence, the use of computer navigation systems in balloon kyphoplasty procedures is recommended.
authors.affiliation: Department of Orthopeadic and Trauma Surgery, University Hospital of Freiburg, Freiburg, Germany. kaywan.izadpanah@uniklinik-freiburg.de
authors.forename: Kaywan
authors.initials: K
authors.lastname: Izadpanah
authors.forename: Gerhard
authors.initials: G
authors.lastname: Konrad
authors.forename: Norbert P
authors.initials: NP
authors.lastname: Südkamp
authors.forename: Michael
authors.initials: M
authors.lastname: Oberst
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005471:Fluoroscopy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000517:prevention & control; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000009:adverse effects / Q000379:methods; D038361:Neuronavigation / Q000379:methods*; D010024:Osteoporosis / Q000150:complications; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*; D013131:Spine / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D054854:Vertebroplasty / Q000295:instrumentation / Q000379:methods*