Evidence map›Paper›PMID 37568527›Full record

ArticleJournal of clinical medicine2023

Free-Hand MIS TLIF without 3D Navigation-How to Achieve Low Radiation Exposure for Both Surgeon and Patient.

Roberto Doria-Medina, Ulrich Hubbe, Christoph Scholz, Ronen Sircar, Johannes Brönner, Herbert Hoedlmoser, Jan-Helge Klingler

Open access · goldAbstract read
In one paragraph

Article in Journal of clinical medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
0.5field-weighted citation impact, top 34% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 2 citations in OpenAlex.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 1 institution in 1 country.

Roberto Doria-MedinaDepartment of Neurosurgery, Medical Center, University of Freiburg, 79106 Freiburg, Germany.ORCID 0000-0001-8180-8674
Ulrich HubbeDepartment of Neurosurgery, Medical Center, University of Freiburg, 79106 Freiburg, Germany.
Christoph ScholzDepartment of Neurosurgery, Medical Center, University of Freiburg, 79106 Freiburg, Germany.
Ronen SircarDepartment of Neurosurgery, Medical Center, University of Freiburg, 79106 Freiburg, Germany.
Johannes BrönnerMirion Technologies (AWST) GmbH, 81739 Munich, Germany.
Herbert HoedlmoserMirion Technologies (AWST) GmbH, 81739 Munich, Germany.ORCID 0000-0001-8341-3457
Jan-Helge KlinglerDepartment of Neurosurgery, Medical Center, University of Freiburg, 79106 Freiburg, Germany.
University of Freiburg · DE

Funding

Wissenschaftliche Gesellschaft Freiburg not applicable
6 · The paper itself

Abstract

backgroundTransforaminal lumbar interbody fusion (TLIF) is one of the most frequently performed spinal fusion techniques, and this minimally invasive (MIS) approach has advantages over the traditional open approach. A drawback is the higher radiation exposure for the surgeon when conventional fluoroscopy (2D-fluoroscopy) is used. While computer-assisted navigation (CAN) reduce the surgeon's radiation exposure, the patient's exposure is higher. When we investigated 2D-fluoroscopically guided and 3D-navigated MIS TLIF in a randomized controlled trial, we detected low radiation doses for both the surgeon and the patient in the 2D-fluoroscopy group. Therefore, we extended the dataset, and herein, we report the radiation-sparing surgical technique of 2D-fluoroscopy-guided MIS TLIF.

methodsMonosegmental and bisegmental MIS TLIF was performed on 24 patients in adherence to advanced radiation protection principles and a radiation-sparing surgical protocol. Dedicated dosemeters recorded patient and surgeon radiation exposure. For safety assessment, pedicle screw accuracy was graded according to the Gertzbein-Robbins classification.

resultsIn total, 99 of 102 (97.1%) pedicle screws were correctly positioned (Gertzbein grade A/B). No breach caused neurological symptoms or necessitated revision surgery. The effective radiation dose to the surgeon was 41 ± 12 µSv per segment. Fluoroscopy time was 64 ± 34 s and 75 ± 43 radiographic images per segment were performed. Patient radiation doses at the neck, chest, and umbilical area were 65 ± 40, 123 ± 116, and 823 ± 862 µSv per segment, respectively.

conclusionsUsing a dedicated radiation-sparing free-hand technique, 2D-fluoroscopy-guided MIS TLIF is successfully achievable with low radiation exposure to both the surgeon and the patient. With this technique, the maximum annual radiation exposure to the surgeon will not be exceeded, even with workday use.

Indexed as

computer assisted navigationconventional fluoroscopyminimally invasive surgeryradiation exposurespine surgerytransforaminal interbody fusion

Identifiers

PMID37568527
PMCPMC10419541
OpenAlexW4385576375

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.