title: [Assessment of the surgeon radiation exposure during a minimally invasive TLIF: Comparison between fluoroscopy and O-arm system].
abstract: BACKGROUND
  Transforaminal lumbar interbody fusion with a minimally invasive approach (MIS TLIF) has become a very popular technique in the treatment of degenerative diseases of the lumbar spine, as it allows a decrease in muscle iatrogenic. However, iterative radiological controls inherent to this technique are responsible for a significant increase in exposure to ionizing radiation for the surgeon. New techniques for radiological guidance (O-arm navigation-assisted) would overcome this drawback, but this remains unproven.
  
  
  OBJECTIVE
  To analyze the exposure of the surgeon to intraoperative X-ray during a MIS TLIF under fluoroscopy and under O-arm navigation-assisted.
  
  
  METHODS
  This prospective study was conducted at the University Hospital of Lille from February to May 2013. Twelve patients underwent a MIS TLIF for the treatment of low-grade spondylolisthesis; six under standard fluoroscopy (group 1) and six under O-arm system (group 2). Passive dosimeters (rings and glasses) and active dosimeters for thorax were used to measure the radiation exposure of the surgeon.
  
  
  RESULTS
  For group 1, the average time of fluoroscopy was 3.718 minutes (3.13-4.56) while no radioscopy was perform on group 2. For the first group, the average exposure dose was 12 μSv (5-20 μSv) on the thorax, 1168 μSv (510-2790 μSv) on the main hand and 179 μSv (103-486 μSv) on the lens. The exposure dose was measured zero on the second group.
  
  
  CONCLUSIONS
  The maximum recommended doses can be reached, mainly for the lens. In addition to the radioprotection measures, O-arm navigation systems are safe alternatives to significantly reduce surgeon exposure.
authors.affiliation: Service de neurochirurgie, Bocage Central, CHRU de Dijon, 14, rue Paul-Gaffarel, 21000 Dijon, France. Electronic address: michael.grelat@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Grelat
authors.affiliation: Service de neurochirurgie, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille, France. Electronic address: fahed.zairi@gmail.com.
authors.forename: F
authors.initials: F
authors.lastname: Zairi
authors.affiliation: Service de neurochirurgie, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille, France. Electronic address: mathilde.quidet@yahoo.fr.
authors.forename: M
authors.initials: M
authors.lastname: Quidet
authors.affiliation: Service de neurochirurgie, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille, France. Electronic address: jpaulo_marinho@yahoo.fr.
authors.forename: P
authors.initials: P
authors.lastname: Marinho
authors.affiliation: Service de neurochirurgie, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille, France. Electronic address: mohamed.allaoui@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Allaoui
authors.affiliation: Service de neurochirurgie, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille, France. Electronic address: richard.assaker@chru-lille.fr.
authors.forename: R
authors.initials: R
authors.lastname: Assaker
mesh_terms: D000328:Adult; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D011446:Prospective Studies; D000069079:Radiation Exposure; D013123:Spinal Fusion / Q000379:methods
keywords: Arthrodèse lombaire transforaminale; Chirurgie du rachis minimale invasive; Exposition aux rayonnements; Fluoroscopie peropératoire; Intraoperative O-arm navigation-assisted; Intraoperative fluoroscopy; Minimally invasive surgery; Neuronavigation O-arm peropératoire; Radiation exposure; Radiation safety; Sûreté radiologique; Transforaminal lumbar interbody fusion