title: Fluoroscopy for transpedicular screw placement in scoliosis: to what extent can radiation exposure be reduced by the freehand technique?
abstract: OBJECTIVE
  In spinal surgery, high doses of radiation are delivered during surgical procedures that require fluoroscopic control. The aim of this study was to determine the amount of radiation delivered from the fluoroscopic unit and also the factors to reduce the amount of radiation during the surgery of adolescent idiopathic scoliosis patients.
  
  
  METHODS
  In this retrospective study 21 patients with adolescent idiopathic scoliosis treated by transpedicular screws between 2009 and 2012 were enrolled the study. Dose Area Product (DAP) values , number of views obtained during screw placement and other data were retrieved from the medical records of the patients.
  
  
  RESULTS
  The mean number of transpedicular screws used was 18. An average of 10,1 vertebrae were instrumented. The mean number of images obtained was 7.76. Mean fluoroscopy time was 7.95 seconds. The total mean DAP was 64.6 cGy.cm < sup > 2 < /sup > .
  
  
  CONCLUSIONS
  The amount of ionizing radiation transmitted to the patient and the surgical team can be reduced by freehand insertion, confirmation of screw position by AP and lateral fluoroscopic views including more than one segment, the use of K-wires as a guide in spinal segments with abnormal pedicular anatomy and neuromonitorization of the patient during the surgical correction of adolescent idiopathic scoliosis.
authors.affiliation: Gulhane Military Medical Academy, Department of Orthopaedics and Traumatology, Ankara, Turkey.
authors.forename: Tolga
authors.initials: T
authors.lastname: Ege
authors.forename: Serkan
authors.initials: S
authors.lastname: Bilgic
authors.forename: Kenan
authors.initials: K
authors.lastname: Koca
authors.forename: Erbil
authors.initials: E
authors.lastname: Oguz
authors.forename: Erden
authors.initials: E
authors.lastname: Kilic
authors.forename: Ozkan
authors.initials: O
authors.lastname: Kose
authors.forename: Ali
authors.initials: A
authors.lastname: Sehırlıoglu
authors.forename: Atilla
authors.initials: A
authors.lastname: Kazanci
authors.forename: Omer
authors.initials: O
authors.lastname: Ersen
mesh_terms: D000293:Adolescent; D001863:Bone Screws / Q000009:adverse effects; D002648:Child; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D016268:Internal Fixators; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome