Can computer-assisted surgery reduce the effective dose for spinal fusion and sacroiliac screw insertion?
BACKGROUND
The increasing use of fluoroscopy-based surgical procedures and the associated exposure to radiation raise questions regarding potential risks for patients and operating room personnel. Computer-assisted technologies can help to reduce the emission of radiation; the effect on the patient's dose for the three-dimensional (3-D)-based technologies has not yet been evaluated.


OBJECTIVE
We determined the effective and organ dose in dorsal spinal fusion and percutaneous transsacral screw stabilization during conventional fluoroscopy-assisted and computer-navigated procedures.


METHODS
We recorded the dose and duration of radiation from fluoroscopy in 20 patients, with single vertebra fractures of the lumbar spine, who underwent posterior stabilization with and without the use of a navigation system and 20 patients with navigated percutaneous transsacral screw stabilization for sacroiliac joint injuries. For the conventional iliosacral joint operations, the duration of radiation was estimated retrospectively in two cases and further determined from the literature. Dose measurements were performed with a male phantom; the phantom was equipped with thermoluminescence dosimeters.


RESULTS
The effective dose in conventional spine surgery using 2-D fluoroscopy was more than 12-fold greater than in navigated operations. For the sacroiliac joint, the effective dose was nearly fivefold greater for nonnavigated operations.


CONCLUSIONS
Compared with conventional fluoroscopy, the patient's effective dose can be reduced by 3-D computer-assisted spinal and pelvic surgery.


METHODS
Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Department of Orthopaedic Trauma, Hand, Plastic, and Reconstructive Surgery, Ulm University Hospital, Steinhoevelstr 9, 89075 Ulm, Germany.
Michael David
MD
Kraus
Gert
G
Krischak
Peter
P
Keppler
Florian T
FT
Gebhard
Uwe H W
UH
Schuetz
D000328:Adult; D000368:Aged; D001863:Bone Screws; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007085:Ilium / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D021621:Imaging, Three-Dimensional; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019047:Phantoms, Imaging; D011446:Prospective Studies; D011829:Radiation Dosage; D011857:Radiographic Image Interpretation, Computer-Assisted; D015641:Radiography, Interventional / Q000295:instrumentation; D012189:Retrospective Studies; D012446:Sacroiliac Joint / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D012447:Sacrum / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation; D013997:Time Factors; D016896:Treatment Outcome