Radiation Exposure During Lumbar Interbody Fusion Surgery Can Be Reduced by Using a Three-Dimensional Patient-Specific Template Guide

Background: The use of posterior lumber interbody fusion (PLIF) using cortical bone trajectory (CBT) with a patient -specific 3D template guide is increasingly widespread. To our knowledge, no studies have extensively evaluated the reduction of radiation exposure when using patient -specific drill template guides. The purpose of this study is to compare the intra-operative radiation dose and surgeon's exposure to radiation in CBT-PLIF when using a patient -specific drill guide with that in traditional minimally invasive (MIS)-PLIF. Methods: In this observational study, we retrospectively compared data from five patients who were treated with single -level CBT-PLIF using a patient -specific drill guide (G group) and five patients who were treated with single -level traditional MIS-PLIF (M group). We compared the surgical time, surgeon's exposure to radiation, and intra-operative radiation time and dose between the two groups of patients. Results: The mean age of the patients was 67.0 years in the M group and 74.2 years in the G group. The average surgical time was 242.8 min in the M group and 189.6 min in the G group (p = 0.020). The surgeon's exposure to radiation was 373.7 pSv in the M group and 81.75 pSv in the G group at chest level outside the protector (p = 0.00092); 42.0 pSv (M group) and 3.6 pSv (G group) at chest level inside the protector (p = 0.0000062); and 4.33 pSv (M group) and 1.20 pSv (G group) at the buttocks of the surgeon (p = 0.0013). Radiation time was 269.8 s (M group) and 56.6 s (G group) (p = 0.0097), and radiation dose was 153.7 mGy (M group) and 30.42 mGy (G group) (p = 0.00057). Conclusion: The patient -specific drill template guide is an invaluable tool that facilitates the safe insertion of CBT screws with a low radiation dose from the outset.