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Radiation Exposure to Surgeon in Minimally Invasive Transforaminal Lumbar Interbody Fusion With Novel Spinal Locators

Fan, Guoxin MD*; Fu, Qingsong MD; Gu, Guangfei MD*; Zhang, Hailong MD*; Guan, Xiaofei MD*; Zhang, Lei MD*; Gu, Xin MD*; He, Shisheng MD*

Journal of Spinal Disorders and Techniques: April 2015 - Volume 28 - Issue 3 - p E173–E180
doi: 10.1097/BSD.0000000000000210

Study Design: A prospective study.

Objective: To further investigate the implication of our surface locator and intradermal locator to reduce the radiation exposure to surgeons in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) surgery.

Summary of Background Data: Our previous studies published in the journal have introduced our novel spinal locators effectively minimizing fluoroscopic time during minimally invasive spinal surgery.

Methods: Twenty patients underwent MIS-TLIF surgery with G-arm fluoroscopy from January 2013 to June 2013. There were 10 patients in group A who underwent standard MIS-TLIF using our spinal locators, and the other 10 in group B underwent conventional MIS-TLIF without spinal locators. The radiation dosages to the arm, the finger, the whole body, thyroid gland, gonad gland, and the eye of the surgeon were measured by thermoluminescence badges for both groups.

Results: All 20 patients (9 male, 11 female), aged from 48 to 77 years old, successfully underwent the surgery. The operation time was 171.20±10.28 minutes for group A and 189.80±11.99 minutes for group B. The fluoroscopy time was 49.60±7.32 seconds for group A and 68.40±7.62 seconds for group B, hence a reduction of 27.49% was observed. There was no correlation between operation time and exposure time for group A or group B. The radiation reduction was 35.28% for the arm, 17.95% for the finger, 45.23% for the whole body, 53.62% for the thyroid gland (protected), 52.44% for the thyroid gland (unprotected), 44% for gonad gland (protected), 36.42% for the gonad gland (unprotected), 59.42% for the eye (protected), and 59.70% for the eye (unprotected).

Conclusion: The study indicated that radiation exposure to the surgeon would be effectively reduced in MIS-TLIF using our surface locator and intradermal locator, and it could be another practical choice for radiation-minimizing strategy.

*Department of Orthopaedics, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai

Department of Orthopaedics, Ningbo No. 2 Hospital, Ningbo, China

G.F. and Q.F. contributed equally.

G.F. and Q.F. designed the study and wrote the manuscript. G.G., H.Z., and X. Gu were involved in the experiment. X. Guang and L.Z. gave critical points. S.H. approved the final version.

The authors declare no conflict of interest.

Reprints: Shisheng He, MD, Department of Orthopaedics, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai 200072, China (e-mail:

Received February 15, 2014

Accepted October 16, 2014

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.