Patient and physician radiation exposure during minimally invasive lumbar decompression: A prospective assessment of X-ray exposure risks

Introduction: Minimally invasive lumbar decompression (mild (R)) is becoming a popular procedure for treating lumbar spinal stenosis (LSS) secondary to hypertrophic ligamentum flavum (LF). The mild (R) procedure is commonly performed under live fluoroscopic guidance and carries a risk of radiation exposure to the patient and healthcare.Methods: One physician performed mild (R) on 41 patients at the Cleveland Clinic Department of Pain Management from October 2019 to December 2021, while wearing a radiation exposure monitor (Mirion Technologies). Mean fluoroscopy time, mean exposure per case, and mean exposure per unilateral level decompressed were the primary outcomes measured. The secondary outcome was to provide a comparison of radiation exposure during similar fluoroscopically guided procedures.Results: Mean patient fluoroscopy exposure time was 2.1 min +/- 0.9 (range: 1.1-5.6) fluoroscopy time per unilateral level decompressed. The mean patient radiation skin exposure from mild (R) was 1.1 +/- 0.9 mGym(2), and the mean total dose was 142.3 +/- 108.6 mGy per procedure. On average, the physician was exposed to an average deep tissue exposure of 4.1 +/- 3.2 mRem, 2.9 +/- 2.2 mRem estimated eye exposure, and 14.7 +/- 11.0 mRem shallow tissue exposure per unilateral level decompressed. An individual physician would exceed the annual exposure limit of 5 Rem after approximately 610 mild (R) procedures per year.Conclusions: This study is an attempt to quantify the radiation exposure to the physician and patient during the mild (R) procedure. Compared with other fluoroscopically guided pain management procedures, patient and physician radiation exposure during mild (R) was low.