# Radiation Exposure and Surgeon Safety During Minimally Invasive Spine Surgery in the Absence of Neuronavigation: A UK Single-Centre Retrospective Study

## TL;DR

Minimally invasive spine surgery without neuronavigation leads to significantly higher radiation exposure for surgeons compared to open surgery.

## Contribution

This study quantifies radiation exposure differences between minimally invasive and open spine surgery in a real-world clinical setting.

## Key findings

- MIS cases required nearly double the number of X-rays compared to open cases.
- Radiation dose for MIS was more than double that of open procedures.
- BMI had minimal impact on radiation exposure differences between the two surgical approaches.

## Abstract

Background: Minimally invasive spine (MIS) surgery has evolved significantly during the past decades; however, it remains dependent on fluoroscopic imaging in many centres throughout the world. Substantial radiation exposure to the patient and surgeon is inevitable in these procedures. The aim of this study is to assess whether MIS surgery without neuro-navigation (NN) leads to excessive radiation exposure.

Methods: We retrospectively analysed all spinal instrumented cases performed at a Level 1 Trauma Centre during a 12-month period. Number of X-rays and radiation generated were measured for both open and MIS cases and compared based on type of procedure and number of levels fused. Dose area product (DAP) dose registered at the end of the case by the X-ray machine. Body Mass Index (BMI) was also analysed to assess the impact it has on X-ray tissue penetration.

Results: In total, 141 instrumented thoracolumbar spinal cases were recorded, 57 MIS and 84 open, with a mean patient age of 55.8 and 57.5 years respectively. Mean BMI was 27.8 for the MIS group and 27.4 for the open group. For MIS cases, a mean of 192.3 X-rays were performed for each case, compared to 89.4 for open cases, while the dose calculated was 0.96 mGym2 for MIS, compared to 0.37 mGym2 for open.

Conclusion: MIS procedures without the use of NN carry a high risk of radiation exposure to the surgeon. Future research should focus on identifying barriers to the widespread adoption of NN.