Prospective Evaluation of a Low-Dose Radiation Fluoroscopy Protocol for Minimally Invasive Transforaminal Lumbar Interbody Fusion

BACKGROUND: Recent research on radiation exposure in minimally invasive surgery for transforaminal lumbar interbody fusion (MIS TLIF) has led to the development of a low-dose radiation fluoroscopy protocol, with resulting reductions in fluoroscopy times and radiation exposures. OBJECTIVE: To prospectively evaluate a previously reported low-dose radiation fluoroscopy protocol for MIS TLIF. METHODS: A prospective evaluation of the low-dose radiation fluoroscopy protocol for MIS TLIF was performed for 65 consecutive patients. Total fluoroscopy time, radiation dose, and operative times were prospectively analyzed for all enrolled patients. RESULTS: Sixty-five consecutive patients (43 women; 22 men) who underwent an MIS TLIF were prospectively enrolled in this study of the low-dose fluoroscopy protocol. A total of 260 pedicle screws were placed. The mean age of the patients was 63 years (range, 46-82 years). They had a mean operative time of 178.7 minutes (range, 119247 minutes), a mean fluoroscopic time of 10.43 seconds (range, 5-24 seconds), and a mean radiation dose of 0.295 mGy x m(2) (range, 0.092-0.314 mGy x m(2)). CONCLUSION: The combination of low-dose pulsed images and digital spot images in a low-dose protocol decreases fluoroscopy times and radiation doses in patients undergoing MIS TLIF without compromising visualization of the bony anatomy or the safety and efficiency of the procedure. The application of this low-dose protocol uncouples the otherwise linear relationship between fluoroscopy times and radiation dose. This is due primarily to the use of the digital spot technique. Equal emphasis should be placed on radiation dose and acquisition time to optimize this protocol.