A retrospective comparison of intraoperative CT and fluoroscopy evaluating radiation exposure in posterior spinal fusions for scoliosis

Abstract

Background: Radiation exposure is a concern in the field of medicine. Deformity spine surgeons depend on modalities that have high exposure through scoliosis x-rays or computed tomography. The use of fluoroscopy has increased with the increased use of pedicle screws. Recently other 3-D imaging devices with navigation have also been brought onto the market to improve accuracy of screw placement. There is concern that because of the use of CT, the radiation dose to the patient is increased, however there is little literature that directly compares the amount of radiation using the 3-D devices to traditional fluoroscopy. Although we know intraoperative CT decreases the amount of radiation to the surgeon and operating room staff, there is limited comparison data for exposure to patients. Our study focused on a comparison of radiation exposure data for pediatric scoliosis patients receiving posterior spinal fusions using traditional fluoroscopy and the Medtronic O-arm in an effort to determine the method most likely to decrease radiation exposure in the pediatric population. Methods: Retrospective review of data in patient charts from two pediatric surgeons practicing in both a University and private hospital setting. Data collected included age, weight, height, diagnosis, Cobb angle, fusion levels, number of screws, and number of hooks, O-arm spins, fluoro doses and O-arm doses. Effective dose was calculated using output measures and radiation doses were compared along a continuum that took into account the amount of correction as indicated by Cobb angle. Results: A total of 57 patients, 25 using the O-arm and 32 using traditional fluoroscopy, were analyzed. Effective dose was calculated and then compared as a factor correlated to curve severity. At lower angles of correction we found no statistically significant difference between methods in terms of effective radiation dose. There was no statistically significant divergence until a Cobb angle correction of greater than 74 degrees, where the Oarm dose was shown to be lower by comparison. Conclusion: We found that regardless of the methods used there is still a significant radiation dose that is utilized in scoliosis procedures. The two methods analyzed did not display statistically significant differences in effective dose for the average case. Safely managing radiation exposure for pediatric patients is of the utmost priority. Healthcare professionals, however, face repeated exposure to radiation over the course of a long career. In our data set the O-Arm system does not increase overall exposure for patients and decreases radiation doses for providers and thereby provides a safe alternative to traditional fluoroscopy without compromising accuracy of implant placement or patient care. Level of Evidence: III.