Table 1.
A summary of cases in 1- to 3-level MIS-TLIF.
Figure 1.
Intraoperative setup of the surgical team and equipment.
A single C-arm was used for fluoroscopic imaging. The operating surgeon stood next to the X-ray tube. The assisting surgeon and radiological technologist were stationed at the opposite site, along with the image intensifier.
Figure 2.
Placement of radiation monitors.
The operating and assisting surgeon and radiological technologist wore thermoluminescent dosimeter (TLD) badges at the thyroid, chest, genitals (unshielded; circles in A), and on the chest (shielded; dotted circles in A). The operating and assisting surgeon wore sterile TLD ring badges on their right middle fingers (B).
Figure 3.
Fluoroscopy was typically involved at 5 steps during MIS-TLIF: preoperative skin marking (A), confirmation of the retractor position (B), placement of the cage (C, D), insertion of the percutaneous pedicle screws (E–I), and placement of the rods (J–L). We used one-shot imaging, which uses short exposure times rather than continuous exposure.
Figure 4.
Protective techniques against excessive radiation exposures.
Surgeons should always pay attention to the location of their hands at every fluoroscopic shots during MIS-TLIF procedures. The hands are often exposed to the X-ray beam while confirming the insertion point of the Jamshidi needle. A long Kocher clamp can be used to hold the Jamshidi needle for keeping a distance from the X-ray tube.
Figure 5.
The mean radiation doses measured at different areas, and mean effective doses in all cases.
The mean radiation doses and effective doses are shown for all cases. The mean radiation doses measured at the operating and assisting surgeons' right middle fingers were significantly higher than those measured elsewhere on the bodies. The mean radiation dose measured at the operating surgeon's genital area was significantly higher than at the lens, thyroid, or chest. Mean effective doses didn't differ significantly among the operating surgeon, assisting surgeon, and radiological technologist.
Table 2.
Mean surgeons' radiation doses of different measurement parts, and mean effective doses in MIS-TLIF (mSv).
Table 3.
Comparison of surgeons' radiation doses between primary and revision surgery in 1-level MIS-TLIF.
Table 4.
Comparison of surgeons' radiation doses between normal-weight (BMI<25) and over-weight patients (BMI>25) in 1-level MIS-TLIF.