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Free-Hand MIS TLIF without 3D Navigation-How to Achieve Low Radiation Exposure for Both Surgeon and Patient – Lumbar Fusion

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The article discusses the use of a radiation-sparing surgical technique called 2D-fluoroscopy-guided minimally invasive transforaminal lumbar interbody fusion (TLIF). TLIF is a commonly performed spinal fusion technique, and the minimally invasive approach has several advantages over the traditional open approach. However, one drawback is the higher radiation exposure for the surgeon when conventional fluoroscopy is used. The study investigated the use of 2D-fluoroscopy-guided and 3D-navigated TLIF and found that low radiation doses were detected for both the surgeon and the patient in the 2D-fluoroscopy group. The study included 24 patients, and the results showed that the radiation-sparing technique achieved successful outcomes with low radiation exposure for both the surgeon and the patient. The article concludes that with this technique, the maximum annual radiation exposure to the surgeon will not be exceeded

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : best situated spine clinic in UK

Published article

CONCLUSIONS: Using a dedicated radiation-sparing free-hand technique, 2D-fluoroscopy-guided MIS TLIF is successfully achievable with low radiation exposure to both the surgeon and the patient. With this technique, the maximum annual radiation exposure to the surgeon will not be exceeded, even with workday use.

Lumbar Fusion Surgery Expert. Best Spinal Surgeon UK
J Clin Med. 2023 Aug 4;12(15):5125. doi: 10.3390/jcm12155125.ABSTRACTBACKGROUND: Transforaminal lumbar interbody fusion (TLIF) is one of the most frequently performed spinal fusion techniques, and this minimally invasive (MIS) approach has advantages over the traditional open approach. A drawback is the higher radiation exposure for the surgeon when conventional fluoroscopy (2D-fluoroscopy) is used. While computer-assisted navigation,

J Clin Med. 2023 Aug 4;12(15):5125. doi: 10.3390/jcm12155125.

ABSTRACT

BACKGROUND: Transforaminal lumbar interbody fusion (TLIF) is one of the most frequently performed spinal fusion techniques, and this minimally invasive (MIS) approach has advantages over the traditional open approach. A drawback is the higher radiation exposure for the surgeon when conventional fluoroscopy (2D-fluoroscopy) is used. While computer-assisted navigation (CAN) reduce the surgeon’s radiation exposure, the patient’s exposure is higher. When we investigated 2D-fluoroscopically guided and 3D-navigated MIS TLIF in a randomized controlled trial, we detected low radiation doses for both the surgeon and the patient in the 2D-fluoroscopy group. Therefore, we extended the dataset, and herein, we report the radiation-sparing surgical technique of 2D-fluoroscopy-guided MIS TLIF.

METHODS: Monosegmental and bisegmental MIS TLIF was performed on 24 patients in adherence to advanced radiation protection principles and a radiation-sparing surgical protocol. Dedicated dosemeters recorded patient and surgeon radiation exposure. For safety assessment, pedicle screw accuracy was graded according to the Gertzbein-Robbins classification.

RESULTS: In total, 99 of 102 (97.1%) pedicle screws were correctly positioned (Gertzbein grade A/B). No breach caused neurological symptoms or necessitated revision surgery. The effective radiation dose to the surgeon was 41 ± 12 µSv per segment. Fluoroscopy time was 64 ± 34 s and 75 ± 43 radiographic images per segment were performed. Patient radiation doses at the neck, chest, and umbilical area were 65 ± 40, 123 ± 116, and 823 ± 862 µSv per segment, respectively.

CONCLUSIONS: Using a dedicated radiation-sparing free-hand technique, 2D-fluoroscopy-guided MIS TLIF is successfully achievable with low radiation exposure to both the surgeon and the patient. With this technique, the maximum annual radiation exposure to the surgeon will not be exceeded, even with workday use.

PMID:37568527 | DOI:10.3390/jcm12155125

The London Spine Unit : best situated spine clinic in UK

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Free-Hand MIS TLIF without 3D Navigation-How to Achieve Low Radiation Exposure for Both Surgeon and Patient

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J Clin Med. 2023 Aug 4;12(15):5125. doi: 10.3390/jcm12155125.ABSTRACTBACKGROUND: Transforaminal lumbar interbody fusion (TLIF) is one of the most frequently performed spinal fusion techniques, and this minimally invasive (MIS) approach has advantages over the traditional open approach. A drawback is the higher radiation exposure for the surgeon when conventional fluoroscopy (2D-fluoroscopy) is used. While computer-assisted navigation

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