The effect of image-guided navigation on radiation exposures during vertebral kyphoplasty

Introduction. Vertebral compression fractures (VCFs) represent a substantial source of pain and disability for patients with osteoporosis or metastatic cancer. Percutaneous vertebral augmentation procedures such as kyphoplasty are highly effective, minimally invasive procedures for the treatment of painful VCFs. Successful performance of these procedures requires substantial use of intraoperative fluoroscopy. Concerns over radiation exposure to operating room staff and patients have spurred advances in image-guided navigation technologies to reduce radiation exposure when performing minimally invasive spinal surgery. Decreased fluoroscopy times have been demonstrated using image-guided navigation but actual dose measurements are lacking. The work presented here seeks to define the effect of intraoperative CT-based image-guided navigation on radiation doses to both the patient and the surgeon during kyphoplasty.;Methods. Two studies were planned. First, a retrospective cohort study was performed analyzing fluoroscopy exposure times and patient-reported outcomes for image-guided and conventional fluoroscopic kyphoplasty procedures. This was followed with a prospective randomized controlled trial (RCT) designed to characterize radiation exposures using direct dosimetry measurements during the procedure of either image-guided or conventional kyphoplasty. Both studies utilized a mobile cone-beam imaging device for both standard 2D fluoroscopy and 3D computed tomography (CT) acquisition.;Results. Clinical outcomes were excellent in both groups and consistent with previously reported results. Both the retrospective and prospective studies revealed a fifty-percent reduction in fluoroscopy exposure times using image-guided navigation. The RCT demonstrated decreased radiation exposures to the surgeon but increased radiation exposure to the patient for the image-guidance cohort.;Conclusion. CT-based image guided kyphoplasty reduces radiation doses to the surgeon performing the procedure. Patient exposure are increased but within acceptable limits for a single procedure. Further studies are warranted to quantify exposures for other procedures requiring intraoperative fluoroscopy.