title: Radiation safety and spine surgery: systematic review of exposure limits and methods to minimize radiation exposure.
abstract: BACKGROUND
  Ionizing radiation is typically used during spine surgery for localization and guidance in instrumentation placement. Minimally invasive (MI) surgical procedures are increasingly popular and often require significantly more fluoroscopy, placing surgeons at risk for increased radiation exposure and radiation-induced complications. This study provides recommendations for minimizing risk of radiation-induced injury to spine surgeons and summarizes studies addressing radiation exposure in spine procedures.
  
  
  METHODS
  The PubMed database was queried for relevant articles pertaining to radiation exposure in spine surgery.
  
  
  RESULTS
  Discectomy, percutaneous pedicle screw placement, MI transforaminal lumbar interbody fusion, MI lateral lumbar interbody fusion, and vertebroplasty/kyphoplasty procedures were assessed. The highest radiation doses were seen with MI pedicle screw placement, MI transforaminal lumbar interbody fusion, vertebroplasty and kyphoplasty, and percutaneous endoscopic lumbar discectomy. Use of lead aprons and thyroid shields reduces effective dose by several orders of magnitude. Proper operator positioning also minimizes radiation exposure. Lead gloves decrease dose to the surgeon's hand from scatter if the hand is out of the x-ray beam most of the time. If prolonged exposure of the hand cannot be avoided, the technician should collimate the surgeon's hand out of the beam or use instruments to position the hand farther from the beam. In addition to using less fluoroscopy, pulsed fluoroscopy can decrease overall dose in a procedure.
  
  
  CONCLUSIONS
  Spine surgeons should reduce their exposure to radiation to minimize risk of potential long-term complications. Strategies include minimizing fluoroscopy use and dose, proper use of protective gear, and appropriate manipulation of fluoroscopic equipment.
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Dushyanth
authors.initials: D
authors.lastname: Srinivasan
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Khoi D
authors.initials: KD
authors.lastname: Than
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Anthony C
authors.initials: AC
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Frank
authors.initials: F
authors.lastname: La Marca
authors.affiliation: Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Page I
authors.initials: PI
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Schermerhorn
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA. Electronic address: ppark@umich.edu.
authors.forename: Paul
authors.initials: P
authors.lastname: Park
mesh_terms: D005471:Fluoroscopy / Q000009:adverse effects*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D011832:Radiation Injuries / Q000453:epidemiology* / Q000209:etiology; D013131:Spine / Q000000981:diagnostic imaging* / Q000601:surgery*
keywords: Fusion; Minimally invasive; Radiation; Safety; Spine