title: Can radiation exposure to the surgeon be reduced with freehand pedicle screw fixation technique in pediatric spinal deformity correction? A prospective multicenter study.
abstract: METHODS
  Prospective multicenter study of patients who underwent pediatric spinal deformity correction with posterior spinal fusion and instrumentation.
  
  
  OBJECTIVE
  To quantify radiation exposure to the surgeon during pedicle screw fixation using the freehand technique in pediatric spinal deformity surgery.
  
  
  BACKGROUND
  Pedicle screw placement in thoracic and lumbar spine for spinal deformity is technically demanding and involves radiation exposure. Many experienced spinals surgeons use the freehand technique for pedicle screw fixation in spinal deformity surgery. There are no studies analyzing radiation exposure to the surgeon regarding freehand pedicle screw fixation technique.
  
  
  METHODS
  A prospective multicenter study was designed to evaluate radiation exposure to the operating spinal surgeon who uses the freehand pedicle screw fixation technique in pediatric spinal deformity correction. All of the operating surgeons placed a gamma radiation dosimeter on their chest outside the lead apron during surgery. Surgeons placed pedicle screws in the pediatric spinal deformity using the freehand technique. We included patients who had undergone correction with posterior spinal fusion and instrumentation with all pedicle screw constructs in this study.
  
  
  RESULTS
  We analyzed 125 patients with pediatric spinal deformity who were operated on between 2008 and 2012. The average fluoroscopic time was 40.5 ± 21 seconds. The overall average fluoroscopic time for placement of a single pedicle screw and per fixation level were 2.6 ± 1.7 seconds and 3.9 ± 2.5 seconds, respectively. In each surgery, the recorded radiation exposure to the surgeon was less than the minimum reportable dose (<0.010 mSv) with an average of 0.0005 ± 0.00013 mSv per surgery.
  
  
  CONCLUSIONS
  The use of freehand technique for pedicle screw fixation in spinal deformity correction requires a minimum amount of fluoroscopic use, hence decreasing radiation exposure to the surgeon and patient.
  
  
  METHODS
  4.
authors.affiliation: *Department of Orthopaedic Surgery, Anadolu Medical Center, Kocaeli, Turkey †Department of Orthopaedic Surgery, Suleyman Demirel University School of Medicine, Isparta, Turkey ‡Department of Orthopaedic Surgery, Umraniye Education and Research Hospital, Istanbul, Turkey; and §Bosphorus Spine Center, Istanbul, Turkey.
authors.forename: H Yener
authors.initials: HY
authors.lastname: Erken
authors.forename: Halil
authors.initials: H
authors.lastname: Burc
authors.forename: Gursel
authors.initials: G
authors.lastname: Saka
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Akmaz
authors.forename: Mehmet
authors.initials: M
authors.lastname: Aydogan
mesh_terms: D000293:Adolescent; D001863:Bone Screws; D002648:Child; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D016273:Occupational Exposure / Q000009:adverse effects / Q000517:prevention & control*; D061646:Operative Time; D011446:Prospective Studies; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control*; D015641:Radiography, Interventional / Q000009:adverse effects; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation*; D013904:Thoracic Vertebrae / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey