• Luis M Tumialán, Justin C Clark, Laura A Snyder, Gary Jasmer, and Frederick F Marciano.
• *Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; ‡Division of Neurological Surgery, Spine Group Arizona, Scottsdale Healthcare System, Scottsdale, Arizona.
• Neurosurgery. 2015 Aug 11.

BackgroundRecent 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.ObjectiveTo prospectively evaluate a previously reported low-dose radiation fluoroscopy protocol for MIS TLIF.MethodsA 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 on all enrolled patients.ResultsSixty-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, 119-247 minutes), a mean fluoroscopic time of 10.43 seconds (range, 5-24 seconds), and a mean radiation dose of mGy × m (0.092-0.314 mGy × m).ConclusionThe 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.AbbreviationsAP, anteroposteriorBMI, weight in kilograms divided by height in meters squared (kg/m)kVp, kilovoltage potentialMIS, minimally invasive surgeryMIS TLIF, minimally invasive surgery for transforaminal lumbar interbody fusionODI, Oswestry Disability IndexTLIF, transforaminal lumbar interbody fusionVAS, visual analog scale.

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