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Radiation Exposure to the Surgeon During Open Lumbar Microdiscectomy and Minimally Invasive Microdiscectomy: A Prospective, Controlled Trial

Mariscalco, Michael W. MD*; Yamashita, Takayuki MD*; Steinmetz, Michael P. MD*; Krishnaney, Ajit A. MD*; Lieberman, Isador H. MD, MBA, FRCS; Mroz, Thomas E. MD*

doi: 10.1097/BRS.0b013e3181ceb976

Study Design. This is a prospective in vivo study comparing radiation exposure to the surgeon during 10 minimally invasive lumbar microdiscectomy cases with 10 traditional open discectomy cases as a control.

Objective. Radiation exposure to the eye, chest, and hand of the operating surgeon during minimally invasive surgery (MIS) and open lumbar microdiscectomy were measured. The Occupational Exposure Guidelines were used to calculate the allowable number of cases per year from the mean values at each of the 3 sites.

Summary of Background Data. Fluoroscopy is a source of ionizing radiation and as such, is a potential health hazard with continued exposure during surgery. Presently, radiation exposure to the surgeon during MIS lumbar microdiscectomy is unknown.

Methods. Radiation exposure to the surgeon (millirads [mR]) per case was measured by digital dosimeters placed at the level of the thyroid/eye, chest, and dominant forearm. Other data collected included operative side and level, side of the surgeon, side of the x-ray source, total fluoroscopy time, and energy output.

Results. The average radiation exposure to the surgeon during open cases was thyroid/eye 0.16 ± 0.22 mR, chest 0.21 ± 0.23 mR, and hand 0.20 ± 0.14 mR. During minimally invasive cases exposure to the thyroid/eye was 1.72 ± 1.52 mR, the chest was 3.08 ± 2.93 mR, and the hand was 4.45 ± 3.75 mR. The difference between thyroid/ eye, chest, and hand exposure during open and minimally invasive cases was statistically significant (P = 0.010, P = 0.013, and P = 0.006, respectively). Surgeons standing in an adjacent substerile room during open cases were exposed to 0.2 mR per case.

Conclusion. MIS lumbar microdiscectomy cases expose the surgeon to significantly more radiation than open microdiscectomy. One would need to perform 1623 MIS microdiscectomies to exceed the exposure limit for whole-body radiation, 8720 cases for the lens of the eye, and 11,235 cases for the hand. Standing in a substerile room during x-ray localization in open cases is not fully protective.

MIS lumbar microdiscectomy exposes the surgeon to significantly more ionizing radiation than open microdiscectomy. The MIS technique appears to be safe from a radiation exposure perspective if appropriate lead protection is worn. Standing in a substerile room during x-ray localization in open cases is not fully protective.

*Spine Institute, Cleveland Clinic, Cleveland, OH;

Cleveland Clinic Florida, Weston, FL.

Address correspondence and reprint requests to Thomas E. Mroz, MD, 9500 Euclid Ave, S80, Cleveland, OH 44195; E-mail:

Acknowledgment date: July 16, 2009. First revision date: October 19, 2009. Second revision date: November 14, 2009. Acceptance date: November 16, 2009.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2011 Lippincott Williams & Wilkins, Inc.