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Zhai X, Li B, Chen K, Chen Z, Shao J, Chen K, Xu Q, Meng D, Fei Q, Jiang L, Bai Y, Li M. Spine Surgery with Electronic Conductivity Device: A Prospectively Multicenter Randomized Clinical Trial and Literature Review. Orthop Surg 2023; 15:2872-2880. [PMID: 37735987 PMCID: PMC10622289 DOI: 10.1111/os.13880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVE Improving accuracy and safety of pedicle screw placement is of great clinical importance. Electronic conductivity device (ECD) can be a promising technique with features of affordability, portability, and real-time detection capabilities. This study aimed to validate the safety and effectiveness of a modified ECD. METHODS The ECD underwent a modification where six lamps of various colors, and it was utilized in a prospectively multicenter randomized controlled clinical trial involving 96 patients across three hospitals from June 2018 to December 2018. The trial incorporated a self-control randomization with an equal distribution of left or right side of vertebral pedicle among two groups: the free-hand group and the ECD group. A total of 496 pedicle screws were inserted, with 248 inserted in each group. The primary outcomes focused on the accuracy of pedicle screw placement and the frequency of intraoperative X-rays. Meanwhile, the secondary indicator measured the time required for pedicle screw placement. Results were presented as means ± SD. Paired samples t-test and χ2 -test were used for comparison. Furthermore, an updated review was conducted, which included studies published from 2006 onwards. RESULTS Baseline patient characteristics were recorded. The primary accuracy outcome revealed a 96.77% accuracy rate in the ECD group, compared to a 95.16% accuracy rate in the free-hand group, with no significant differences noted. In contrast, ECD demonstrated a significant reduction in radiation exposure frequency when compared to the free-hand group (1.11 ± 0.32 vs. 1.30 ± 0.53; p < 0.001), resulting in a 14.6% reduction. Moreover, ECD displayed a decrease of 30.38% in insertion time (70.88 ± 30.51 vs. 101.82 ± 54.00 s; p < 0.001). According to the results of the 21 studies, ECD has been utilized in various areas of the spine such as the atlas, thoracic and lumbar spine, as well as sacral 2-alar-iliac. The accuracy of ECD ranged from 85% to 100%. CONCLUSION The prospectively randomized trial and the review indicate that the use of ECD presents a secure and precise approach to the placement of pedicle screws, with the added benefit of reducing both procedure time and radiation exposure.
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Affiliation(s)
- Xiao Zhai
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
| | - Bo Li
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
| | - Kai Chen
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
| | - Ziqiang Chen
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
| | - Jie Shao
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
| | - Kai Chen
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
| | - Qintong Xu
- Department of Orthopaedic Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Dehua Meng
- Department of Orthopaedic Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Qinming Fei
- Department of Orthopaedic Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Leisheng Jiang
- Spine Center, Xinhua HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | - Yushu Bai
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
| | - Ming Li
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
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Oki T, Lefor AK, Nakamura K, Higashi T, Oki I. Reduction in Radiation Exposure in Minimally Invasive Pedicle Screw Placement Using a Tubular Retractor: A Pilot Study. Tomography 2022; 9:12-24. [PMID: 36648989 PMCID: PMC9844279 DOI: 10.3390/tomography9010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/12/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Percutaneous pedicle screw (PPS) placement is a minimally invasive spinal procedure that has been rapidly adopted over the last decade. However, PPS placement has elicited fear of increased radiation exposure from some surgeons, medical staff, and patients. This is because PPS placement is performed using a K-wire, and the operator must perform K-wire insertion into the pedicle under fluoroscopy. In order to prevent erroneous insertion, there are many occasions when direct insertion is required during radiation exposure, and the amount of radiation exposure to hands and fingers in particular increases. Although these problems are being addressed by navigation systems, these systems are still expensive and not widely available. Attempts have been made to address this situation using instrumentation commonly used in spinal surgery. First, it was considered to visualize anatomical bone markers using a tubular retractor and a microscope. In addition, the use of a self-drilling pin was adopted to locate the pedicle in a narrower field of view. Based on these considerations, a minimally invasive and highly accurate pedicle screw placement technique was developed while avoiding direct radiation exposure. This study evaluated radiation exposure and accuracy of pedicle screw placement using this new procedure in one-level, minimally invasive, transforaminal lumbar interbody fusion (MIS-TLIF). MATERIALS AND METHODS Data were collected retrospectively to review pedicle screw placement in single-level MIS TLIFs using a tubular retractor under a microscope. The total fluoroscopy time, radiation dose, and screw placement accuracy were reviewed. Extension of operating time was also evaluated. RESULTS Twenty-four patients underwent single-level MIS TLIFs, with placement of 96 pedicle screws. There were 15 females and 9 males, with an average age of 64.8 years and a mean body mass index of 25.5 kg/m2. The mean operating time was 201.8 min. The mean fluoroscopic time was 26.8 s. The mean radiation dose of the area dose product was 0.0706 mGy∗m2. The mean radiation dose of air kerma was 6.0 mGy. The mean radiation dose of the entrance skin dose was 11.31 mGy. Postoperative computed tomography scans demonstrated 93 pedicle screws confined to the pedicle (97%) and three pedicle screw breaches (3.2%; two lateral, one medial). A patient with screw deviation of the medial pedicle wall developed right-foot numbness necessitating reoperation. There were no complications after reoperation. The average added time with this combined procedure was 39 min (range 16-69 min) per patient. CONCLUSIONS This novel pedicle screw insertion technique compares favorably with other reports in terms of radiation exposure reduction and accuracy and is also useful from the viewpoint of avoiding direct radiation exposure to hands and fingers. It is economical because it uses existing spinal surgical instrumentation.
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Affiliation(s)
- Takeshi Oki
- Department of Orthopedic Surgery, Yuki Hospital, 9629-1 Yuki, Yuki-City 307-0001, Ibaraki, Japan
- Correspondence: ; Tel.: +81-296334161
| | - Alan Kawarai Lefor
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-City 329-0498, Tochigi, Japan
| | - Kentaro Nakamura
- Department of Orthopedic Surgery, Yuki Hospital, 9629-1 Yuki, Yuki-City 307-0001, Ibaraki, Japan
| | - Takahiro Higashi
- Department of Orthopedic Surgery, Shin Oyama City Hospital, 2251-1 Hitotonoya, Oyama-City 323-0827, Tochigi, Japan
| | - Isao Oki
- Department of Orthopedic Surgery, Yuki Hospital, 9629-1 Yuki, Yuki-City 307-0001, Ibaraki, Japan
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Makanjee CR, Lipscombe E, Haniz AN, Cho YS. Students' and Qualified Radiographers' Perspectives and Understanding on Occupational Dose Monitoring and Prevention Strategies. HEALTH PHYSICS 2021; 121:166-173. [PMID: 33935156 DOI: 10.1097/hp.0000000000001427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
ABSTRACT Effective implementation and ongoing monitoring of occupational radiation safety and protection is key for radiographers as prolonged exposure to ionizing radiation can increase the risk of long-term ill health effects. It is important that radiographers are aware of what is required of them to remain within the permitted dose limit. Topics and training on dose monitoring and occupational practice safety and practice are embedded in both undergraduate and postgraduate courses and ongoing as part of continuous professional development. However, whether these are accurately, effectively implemented and adhered too in practice needs to be monitored. This study aimed to investigate students and radiographers' awareness, observations, and understandings of their compliance to occupational radiation safety and protection and monitoring thereof in the clinical setting. A cross sectional survey design with a questionnaire consisting of closed and open-ended items were used. The data were analysed with the use of SPSS statistical software tool. The response rates for student radiographers were 62% and qualified radiographers 23.19%. Most participants indicated that they were knowledgeable on best practice methods regarding radiation protection and safety. However, regarding the importance of personal monitoring devices, the responses varied and there were some inconsistencies. The perspectives of participants on rotating through different imaging examination types revealed that of least importance was the occupational exposure. Students were focused as part of their training on acquiring the necessary skills to conduct imaging examinations. Qualified radiographers focused on upkeeping their skills when it came to their rotation between the general and specialized imaging examinations. To overcome some of these inconsistencies it is recommended that standardized practice guidelines be reviewed by both the academic institution and the clinical training sites enforcing the importance of dose monitoring and radiation safety and best practice principles.
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Affiliation(s)
- Chandra R Makanjee
- Department of Medical Radiation Sciences, Faculty of Health, University of Canberra, Australian Capital Territory, Australia
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Koga H. A new protective method to reduce radiation exposure. JOURNAL OF SPINE SURGERY (HONG KONG) 2020; 6:1-2. [PMID: 32309639 PMCID: PMC7154360 DOI: 10.21037/jss.2019.12.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 12/24/2019] [Indexed: 06/11/2023]
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Sirufo MM, Ginaldi L, De Martinis M. Nailfold Capillaroscopic Findings in an Orthopedic Surgeon: Reversible Abnormalities after the Cessation of Radiation Exposure. Radiat Res 2019; 193:236-240. [PMID: 31877253 DOI: 10.1667/rr15435.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Interventional fluoroscopy is a leading source of occupational ionizing radiation exposure for medical personnel. For example, orthopedic surgeons represent one occupation where the risk of exposure is large. This occupational hazard is the result of a cumulative dose of radiation over time. Adverse health effects induced by low-dose radiation exposure can arise from daily procedures performed over an entire career. Many of the radiation-induced effects that may develop are transient erythema, permanent epilation, dry desquamation, dermal necrosis and telangiectasia; these effects have occurred on the skin of fingers of interventionalists. Nailfold videocapillaroscopy (NVC) is a non-invasive technique useful for early detection of radiation-induced effects on microcirculation of fingernails. Here we report on a case of an orthopedic surgeon exposed to radiation for 30 years during his professional career. He performed NVC before and after the end of his professional career, and regression of the microcirculatory abnormalities were documented after cessation of radiation exposure. To our knowledge, this is the first published work in which the regression of chronic low-dose radiation-induced alterations of finger microvessels have been described and documented.
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Affiliation(s)
- Maria Maddalena Sirufo
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.,Department of Allergology and Clinical Immunology Unit AUSL 04, Teramo, Italy
| | - Lia Ginaldi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.,Department of Allergology and Clinical Immunology Unit AUSL 04, Teramo, Italy
| | - Massimo De Martinis
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.,Department of Allergology and Clinical Immunology Unit AUSL 04, Teramo, Italy
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Murata S, Iwasaki H, Natsumi Y, Minagawa H, Yamada H. Vascular Evaluation around the Cervical Nerve Roots during Ultrasound-Guided Cervical Nerve Root Block. Spine Surg Relat Res 2019; 4:18-22. [PMID: 32039292 PMCID: PMC7002060 DOI: 10.22603/ssrr.2019-0006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 06/04/2019] [Indexed: 02/02/2023] Open
Abstract
Introduction To carry out ultrasound-guided cervical nerve root block (CNRB) safely, we investigated the frequency of risky blood vessels around the target nerve root and within the imaginary needle pathway in the actual injecting position. Methods 30 patients (20 men, 10 women) with cervical radiculopathy who received ultrasound-guided CNRB were included in this study. We defined a risky blood vessel as an artery existing within 4 mm from the center of the target nerve root or located in the range of 2 mm above or below the imaginary needle pathway. Results Using the color Doppler method, the frequency of a risky blood vessel existing around 4 mm from the center of the C5 nerve root was 3.3% (1/30), whereas it was 3.3% (1/30) for the C6 nerve root and 23.3% (7/30) for the C7 nerve root. Hence, the C7 level had more blood vessels close to the target nerve root compared to the C5 and C6 levels, but there was no significant difference (p = 0.0523). On the other hand, the frequency of a risky blood vessel existing within 2 mm above and below the imaginary needle pathway was 3.3% (1/30) for the C5 nerve root, whereas it was 3.3% (1/30) for the C6 nerve root and 10.0% (3/30) for the C7 nerve root. The C7 level had more blood vessels within the needle pathway compared to the C5 and C6 levels, but there was no significant difference (p = 0.301). Conclusions To reduce the risk of unintended intravascular injections, more careful checking for the presence or absence of blood vessels at the C7 level using color Doppler is necessary.
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Affiliation(s)
- Shizumasa Murata
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroshi Iwasaki
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Yuta Natsumi
- Department of Orthopedic Surgery, Shingu Municipal Medical Center, Wakayama, Japan
| | - Hiroshi Minagawa
- Department of Orthopedic Surgery, Johto Orthopedic Clinic, Akita, Japan
| | - Hiroshi Yamada
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
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Omi H, Itabashi T, Nagaoki T, Ogawa T, Tomita T, Sato H, Ito J. Protecting Surgeons' Fingers from Radiation Exposure during Lumbosacral Selective Nerve Root Block. Spine Surg Relat Res 2019; 3:178-182. [PMID: 31435572 PMCID: PMC6690092 DOI: 10.22603/ssrr.2018-0056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/04/2018] [Indexed: 11/30/2022] Open
Abstract
Introduction Fluoroscopy-guided selective nerve root block (SNRB) is useful for the diagnosis and treatment of nerve root pain. However, the procedure exposes the surgeon's hands to radiation. Therefore, the purpose of this randomized prospective study was to assess the radiation exposure per unit time of the surgeon's fingers during performance of a lumbosacral SNRB and to calculate the annual exposure time limits for four hand-protection methods. Methods We prospectively recruited patients scheduled for an SNRB and measured the radiation exposure using a ring-type passive radiation dosimetry device attached to the distal phalanx of the index finger of the hand performing the needle placement. Patients were randomly divided into the following four groups: a) the direct exposure group, b) the 0.03-mmPb glove group, c) the 0.25-mmPb glove group, and d) the forceps group (in which the needle was held using forceps such that the fingers did not enter the irradiation field). Results We recruited 40 consecutive patients (16 men and 24 women), with a mean age of 69 years. In all cases, SNRB was successfully performed without complications. The average exposure per hour for each of the four groups was as follows: 0.67 ± 0.56 mSv/s in the direct exposure group, 0.12 ± 0.07 mSv/s in the 0.03-mmPb glove group, 0.019 ± 0.02 mSv/s in the 0.25-mmPb glove group, and 0.001 ± 0.004 mSv/s in the forceps group (p < 0.01). The average annual exposure time limit was 12.4 min in the direct exposure group, 67.9 min in the 0.03-mmPb glove group, 7.5 h in the 0.25-mmPb glove group, and 5.0 days in the forceps group. Conclusions Using a radiation reduction glove or forceps greatly decreased the radiation exposure and increased the annual exposure time limit for SNRB.
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Affiliation(s)
- Hirotsugu Omi
- Department of Orthopedic Surgery, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Taito Itabashi
- Department of Orthopedic Surgery, Towada City Hospital, Aomori, Japan
| | - Toshihide Nagaoki
- Department of Orthopedic Surgery, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Tetsuya Ogawa
- Department of Orthopedic Surgery, Mutsu General Hospital, Aomori, Japan
| | - Takashi Tomita
- Department of Orthopedic Surgery, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Hideki Sato
- Department of Orthopedic Surgery, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Junji Ito
- Department of Orthopedic Surgery, Aomori Prefectural Central Hospital, Aomori, Japan
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Comparison of bilateral versus unilateral decompression incision of minimally invasive transforaminal lumbar interbody fusion in two-level degenerative lumbar diseases. INTERNATIONAL ORTHOPAEDICS 2018; 42:2835-2842. [PMID: 29754188 DOI: 10.1007/s00264-018-3974-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 05/04/2018] [Indexed: 02/03/2023]
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