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Can Radiation Exposure to the Surgeon Be Reduced With Freehand Pedicle Screw Fixation Technique in Pediatric Spinal Deformity Correction? A Prospective Multicenter Study

Erken, H. Yener MD*; Burc, Halil MD; Saka, Gursel MD; Akmaz, Ibrahim MD*; Aydogan, Mehmet MD§

Spine:
doi: 10.1097/BRS.0000000000000172
Surgery
Abstract

Study Design. Prospective multicenter study of patients who underwent pediatric spinal deformity correction with posterior spinal fusion and instrumentation.

Objective. To quantify radiation exposure to the surgeon during pedicle screw fixation using the freehand technique in pediatric spinal deformity surgery.

Summary of Background Data. Pedicle screw placement in thoracic and lumbar spine for spinal deformity is technically demanding and involves radiation exposure. Many experienced spinals surgeons use the freehand technique for pedicle screw fixation in spinal deformity surgery. There are no studies analyzing radiation exposure to the surgeon regarding freehand pedicle screw fixation technique.

Methods. A prospective multicenter study was designed to evaluate radiation exposure to the operating spinal surgeon who uses the freehand pedicle screw fixation technique in pediatric spinal deformity correction. All of the operating surgeons placed a gamma radiation dosimeter on their chest outside the lead apron during surgery. Surgeons placed pedicle screws in the pediatric spinal deformity using the freehand technique. We included patients who had undergone correction with posterior spinal fusion and instrumentation with all pedicle screw constructs in this study.

Results. We analyzed 125 patients with pediatric spinal deformity who were operated on between 2008 and 2012. The average fluoroscopic time was 40.5 ± 21 seconds. The overall average fluoroscopic time for placement of a single pedicle screw and per fixation level were 2.6 ± 1.7 seconds and 3.9 ± 2.5 seconds, respectively. In each surgery, the recorded radiation exposure to the surgeon was less than the minimum reportable dose (<0.010 mSv) with an average of 0.0005 ± 0.00013 mSv per surgery.

Conclusion. The use of freehand technique for pedicle screw fixation in spinal deformity correction requires a minimum amount of fluoroscopic use, hence decreasing radiation exposure to the surgeon and patient.

Level of Evidence: 4

In Brief

Because of the limited use of fluoroscopy, the surgeon was exposed to only a minimum amount of radiation during the placement of pedicle screws on the spine using the freehand technique.

Author Information

*Department of Orthopaedic Surgery, Anadolu Medical Center, Kocaeli, Turkey

Department of Orthopaedic Surgery, Suleyman Demirel University School of Medicine, Isparta, Turkey

Department of Orthopaedic Surgery, Umraniye Education and Research Hospital, Istanbul, Turkey; and

§Bosphorus Spine Center, Istanbul, Turkey.

Address correspondence and reprint requests to H. Yener Erken, MD, Department of Orthopaedic Surgery, Anadolu Medical Center, Cumhuriyet, Mahallesi 2255 Sokak No. 3, Gebze 41400, Kocaeli, Turkey; E-mail: yenererken@yahoo.com

Acknowledgment date: September 23, 2013. Revision date: November 15, 2013. Acceptance date: December 9, 2013.

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

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2014 by Lippincott Williams & Wilkins