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Radiation Exposure to the Surgeon During Percutaneous Endoscopic Lumbar Discectomy: A Prospective Study

Ahn, Yong, MD, PhD*; Kim, Chang-Ho, RT; Lee, June Ho, MD*; Lee, Sang-Ho, MD, PhD*; Kim, Jin-Sung, MD

doi: 10.1097/BRS.0b013e318275ca58

Study Design. A prospective study.

Objective. The purpose of this study was to determine the radiation dose to which the surgeons are exposed during percutaneous endoscopic lumbar discectomy (PELD) and to calculate the allowable number of cases per year.

Summary of Background Data. Transforaminal PELD is a minimally invasive technique for soft disc herniation. Minimal invasiveness can be achieved through the use of fluoroscopy and endoscopy. The radiation dose to the surgeon during PELD is unknown.

Methods. The occupational radiation dose absorbed by 3 spinal surgeons performing 30 consecutive PELDs (33 levels) during a 3-month period was evaluated. Transforaminal PELDs were performed according to the standard technique. The radiation exposure of the neck, chest, arm, and both hands of the surgeons was measured. Occupational exposure guidelines of National Council on Radiation Protection & Measurements were used to calculate the allowable number of procedures per year.

Results. The mean operation time was 49.8 minutes, and the mean fluoroscopy time was 2.5 minutes. No significant correlations were found between operation time and fluoroscopy time. The calculated radiation doses per operated level were as follows: neck, 0.0785 mSv; chest, 0.1718 mSv; right upper arm, 0.0461 mSv; left ring finger, 0.7318 mSv; and right ring finger, 0.6694 mSv. The protective effects of a lead collar and lead apron were demonstrated by the reduction of the radiation dose by 96.9% and 94.2%, respectively. Therefore, with regard to whole-body radiation, 5379 operations can be performed per year using a lead apron, whereas only 291 operations can be performed without using a lead apron. Moreover, 1910 operations can be performed within the occupational exposure limit for the eyes (150 mSv), and 683 operations can be performed within the occupational exposure limit for the hands (500 mSv).

Conclusion. Without radiation shielding, a surgeon performing 291 PELDs annually would be exposed to the maximum allowable radiation dose. Given the measurable lifetime radiation hazards to the surgeon, the use of adequate protective equipment is essential to reducing exposure during PELD.

A prospective study on radiation exposure to the surgeon during percutaneous endoscopic discectomy was performed. Without radiation shielding, approximately 291 PELD procedures can be performed per year. The lifetime radiation hazards to a surgeon are not negligible. Therefore, proper protective techniques are essential to mitigate exposure.

*Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea

Division of Radiology, Wooridul Spine Hospital, Seoul, Korea

Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.

Address correspondence and reprint requests to Yong Ahn, MD, PhD, Department of Neurosurgery, Wooridul Spine Hospital, 445 Hakdong-ro, Gangnam-gu, Seoul, 135-100 Korea; E-mail:

Acknowledgment date: June 22, 2012. Revision date: September 17, 2012. Acceptance date: September 19, 2012.

The device(s)/drug(s) is/are FDA approved or approved by corresponding national agency for this indication.

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2013 Lippincott Williams & Wilkins, Inc.