Radiation Exposure to the Surgeon During Ultrasound-Assisted Transforaminal Percutaneous Endoscopic Lumbar Discectomy: A Prospective Study.
OBJECTIVE
To determine the radiation dose to the surgeon during ultrasound-assisted transforaminal percutaneous endoscopic lumbar discectomy (PELD) for lumbar disc herniation, and to investigate whether the usage of ultrasonography could reduce the radiation exposure to the surgeon.


METHODS
The stages of needle insertion and foraminal plasty for transforaminal PELD were performed under ultrasound guidance and confirmed by fluoroscopy according to the standard technique by 2 spinal surgeons separately in 25 transforaminal PELDs (25 levels). The radiation exposure dose of the surgeons' chest above and below the shielding and the fluoroscopy time were recorded. The effective dose and number of possible levels per year within the yearly occupational exposure limit (OEL) were calculated. The radiation dose per level and fluoroscopy time between ultrasound-assisted PELD and fluoroscopy-assisted PELD were compared.


RESULTS
The mean operation time and fluoroscopy time were 67.6 ± 14.6 minutes and 2.9 ± 0.7 seconds, respectively. The mean effective dose to the surgeons per level was 1.3 ± 0.6 μSv. One surgeon could perform PELDs at 38,462 levels per year without exceeding the OEL for whole-body radiation wearing a lead apron, and 1938 levels per year without using any shielding devices. Ultrasound-assisted PELD had significantly less radiation dose per level at the chest below and above apron, effective dose per level, and fluoroscopy time, compared with fluoroscopy-assisted PELD (all P < 0.05).


CONCLUSIONS
The method of ultrasound-assisted needle insertion and foraminal plasty in transforaminal PELD can reduce radiation exposure to the surgeons compared with fluoroscopy-assisted PELD.
Department of Orthopedics, Southern Medical University, Guangzhou, P.R. China; Department of Orthopedics, First People's Hospital of Foshan, Foshan, P.R. China.
Ruihui
R
Wu
Department of Orthopedics, First People's Hospital of Foshan, Foshan, P.R. China.
Xuqiang
X
Liao
Department of Orthopedics, Southern Medical University, Guangzhou, P.R. China; Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, P.R. China. Electronic address: xiahong88@yeah.net.
Hong
H
Xia
D000293:Adolescent; D000328:Adult; D000368:Aged; D017587:Diskectomy, Percutaneous / Q000379:methods*; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000379:methods; D016273:Occupational Exposure / Q000517:prevention & control*; D011446:Prospective Studies; D000069079:Radiation Exposure / Q000517:prevention & control*; D066231:Surgeons / Q000592:standards; D018084:Ultrasonography, Interventional / Q000009:adverse effects*; D055815:Young Adult
Discectomy; Percutaneous endoscopy; Radiation dosage; Radiation exposure; Ultrasound