• Ying Jiang, Hong-Rui Wang, Pan-Feng Wang, and Shuo-Gui Xu.
• Department of Neurosurgery, Shanghai Chang Zheng Hospital affiliated to China Second Military Medical University, 415 Feng Yang Rd, 200003, Shanghai, PR China. Electronic address: yjiang1@vt.edu.
• Injury. 2019 Apr 1; 50 (4): 859-863.

ObjectThe intraoperative fluoroscopy has been widely used in modern neuro-spinal surgery due to the overwhelming trend toward minimal-access surgery. However, both patients and surgical personnel were under ionizing-radiation exposure during fluoroscopy usage. Since the fluoroscopy constitutes the vast majority of radiation exposure for both surgeons and patients, the development and improvement of new interventional possibilities are of great importance and interests.Patients And MethodsA total of 20 patients were included in the current study, who received thoracic-spinal tumor resection via posterior midline approach. In comparison to the conventional C-Arm mobile fluoroscopy machine, the Surgical Approach Visualization and Navigation (SAVN) System was used to evaluate the effectiveness in reducing radiation.ResultsThe pain intensity and Japanese Orthopedic Association Score were equally ameliorated in patients of two groups. However, compared to C-arm group, the SAVN significantly reduced the screening time from 26.8 + 12.4 to 17.1 + 9.2 s (36.2% radiation reduction, P < 0.05), which was mainly due to the significant reduction of radiation attempts (from 12.8 + 4.9 to 7.1 + 5.5 times, P < 0.05). For patients, the direct and scatter radiation dose dropped 30.4% (P < 0.05) in the surgical region and 47.6% (P < 0.01) in the non-surgical region by using the SAVN System. Additionally, the tumor diameter/skin incision ratio increased from 0.39 + 0.4 to 0.47+ 0.28 after SAVN usage. Meanwhile, thedosimeter showed that the radiation dose to the primary surgeon was also lower in the SAVN group (72.1% reduction, P < 0.01).ConclusionComparing the conventional C-arm, the SAVN System based thoracic-spinal surgery significantly lowered radiation duration and dosage application towards both surgeons and patients.Copyright © 2019 Elsevier Ltd. All rights reserved.

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