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Is navigation beneficial for transforaminal endoscopic lumbar foraminotomy? A preliminary comparison study with fluoroscopic guidance

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Abstract

Purpose

The primary purpose of this study was to determine radiation exposure of the surgeon during transforaminal endoscopic lumbar foraminotomy (TELF). Secondary purpose of this study was to compare clinical and radiologic outcomes between TELF under C-arm fluoroscopic guidance (C-TELF) and O-arm navigation-guided TELF (O-TELF).

Methods

The author reviewed patients’ medical records who underwent TELF at our institute from June 2015 to November 2022. A total of 40 patients were included (18 patients with C-TELF and 22 with O-TELF). Basic demographic data were collected. Preoperative/postoperative visual analog scale (VAS) and Oswestry Disability Index (ODI) were recorded at the outpatient clinic. Radiologic features were compared on X-rays at each follow-up. The degree of foraminal expansion was measured/compared through MRI. In the C-TELF group, the amount of exposure was calculated with a dosimeter.

Results

Average surgeon's effective dose in the C-TELF group was 0.036 mSv. In the case of the O-TELF group, there was no radiation exposure during operation. However, the operation time in the O-TELF group was about 37 min longer than that in the C-TELF group. There were significant improvements in VAS/ODI after operation in both groups. Complications were identified in three patients.

Conclusion

O-TELF showed similarly favorable clinical and radiologic outcomes to C-TELF in lumbar foraminal stenosis, including complication rate. Compared to C-TELF, O-TELF has an advantage of not wearing a lead apron since the operator is not exposed to radiation. However, the operation time was longer with O-TELF due to O-arm setting time. Because there are pros and cons, the choice of surgical method depends on the surgeon’s preference.

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References

  1. Kunogi J, Hasue M (1991) Diagnosis and operative treatment of intraforaminal and extraforaminal nerve root compression. Spine (Phila Pa 1976) 16:1312–1320. https://doi.org/10.1097/00007632-199111000-00012

    Article  CAS  PubMed  Google Scholar 

  2. Porter RW, Hibbert C, Evans C (1984) The natural history of root entrapment syndrome. Spine (Phila Pa 1976) 9:418–421. https://doi.org/10.1097/00007632-198405000-00017

    Article  CAS  PubMed  Google Scholar 

  3. Vanderlinden RG (1984) Subarticular entrapment of the dorsal root ganglion as a cause of sciatic pain. Spine (Phila Pa 1976) 9:19–22. https://doi.org/10.1097/00007632-198401000-00006

    Article  CAS  PubMed  Google Scholar 

  4. Kim JY, Kim HS, Jeon JB, Lee JH, Park JH, Jang IT (2021) The novel technique of uniportal endoscopic interlaminar contralateral approach for coexisting L5–S1 lateral recess, foraminal, and extraforaminal stenosis and its clinical outcomes. J Clin Med. https://doi.org/10.3390/jcm10071364

    Article  PubMed  PubMed Central  Google Scholar 

  5. Wiltse LL, Spencer CW (1988) New uses and refinements of the paraspinal approach to the lumbar spine. Spine (Phila Pa 1976) 13:696–706

    Article  CAS  PubMed  Google Scholar 

  6. Momin AA, Steinmetz MP (2020) Evolution of minimally invasive lumbar spine surgery. World Neurosurg 140:622–626. https://doi.org/10.1016/j.wneu.2020.05.071

    Article  PubMed  Google Scholar 

  7. Yoon JW, Wang MY (2019) The evolution of minimally invasive spine surgery: JNSPG 75th anniversary invited review article. J Neurosurg Spine SPI 30:149–158. https://doi.org/10.3171/2018.11.SPINE181215

    Article  Google Scholar 

  8. Sembrano JN, Santos ER, Polly DW Jr (2014) New generation intraoperative three-dimensional imaging (O-arm) in 100 spine surgeries: does it change the surgical procedure? J Clin Neurosci 21:225–231. https://doi.org/10.1016/j.jocn.2013.04.011

    Article  PubMed  Google Scholar 

  9. Kim TT, Johnson JP, Pashman R, Drazin D (2016) Minimally invasive spinal surgery with intraoperative image-guided navigation. BioMed Res Int 2016:5716235. https://doi.org/10.1155/2016/5716235

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Jenkins NW, Parrish JM, Sheha ED, Singh K (2020) Intraoperative risks of radiation exposure for the surgeon and patient. Ann Transl Med 9:84

    Article  Google Scholar 

  11. Blakely EA (2000) Biological effects of cosmic radiation: deterministic and stochastic. Health Phys 79:495–506. https://doi.org/10.1097/00004032-200011000-00006

    Article  CAS  PubMed  Google Scholar 

  12. Fitousi NT, Efstathopoulos EP, Delis HB, Kottou S, Kelekis AD, Panayiotakis GS (2006) Patient and staff dosimetry in vertebroplasty. Spine (Phila Pa 1976) 31:E884–889; discussioin E890. https://doi.org/10.1097/01.brs.0000244586.02151.18

  13. Padovani R, Rodella CA (2001) Staff dosimetry in interventional cardiology. Radiat Prot Dosim 94:99–103. https://doi.org/10.1093/oxfordjournals.rpd.a006490

    Article  CAS  Google Scholar 

  14. Sharif S, Afsar A (2018) Learning curve and minimally invasive spine surgery. World Neurosurg 119:472–478. https://doi.org/10.1016/j.wneu.2018.06.094

    Article  PubMed  Google Scholar 

  15. Wang H, Huang B, Li C, Zhang Z, Wang J, Zheng W, Zhou Y (2013) Learning curve for percutaneous endoscopic lumbar discectomy depending on the surgeon’s training level of minimally invasive spine surgery. Clin Neurol Neurosurg 115:1987–1991. https://doi.org/10.1016/j.clineuro.2013.06.008

    Article  PubMed  Google Scholar 

  16. Son S, Ahn Y, Lee SG, Kim WK, Yoo BR, Jung JM, Cho J (2021) Learning curve of percutaneous endoscopic transforaminal lumbar discectomy by a single surgeon. Medicine (Baltimore) 100:e24346. https://doi.org/10.1097/md.0000000000024346

    Article  PubMed  Google Scholar 

  17. Santos ER, Ledonio CG, Castro CA, Truong WH, Sembrano JN (2012) The accuracy of intraoperative O-arm images for the assessment of pedicle screw postion. Spine (Phila Pa 1976) 37:E119-125. https://doi.org/10.1097/BRS.0b013e3182257cae

    Article  PubMed  Google Scholar 

  18. Shao X, Huang Z, Yang J, Deng Y, Yang J, Sui W (2021) Efficacy and safety for combination of t-EMG with O-arm assisted pedicle screw placement in neurofibromatosis type I scoliosis surgery. J Orthop Surg Res 16:731. https://doi.org/10.1186/s13018-021-02882-9

    Article  PubMed  PubMed Central  Google Scholar 

  19. Hubbe U, Sircar R, Scheiwe C, Scholz C, Kogias E, Kruger MT, Volz F, Klingler JH (2015) Surgeon, staff, and patient radiation exposure in minimally invasive transforaminal lumbar interbody fusion: impact of 3D fluoroscopy-based navigation partially replacing conventional fluoroscopy: study protocol for a randomized controlled trial. Trials 16:142. https://doi.org/10.1186/s13063-015-0690-5

    Article  PubMed  PubMed Central  Google Scholar 

  20. Srinivasan D, Than KD, Wang AC, La Marca F, Wang PI, Schermerhorn TC, Park P (2014) Radiation safety and spine surgery: systematic review of exposure limits and methods to minimize radiation exposure. World Neurosurg 82:1337–1343. https://doi.org/10.1016/j.wneu.2014.07.041

    Article  PubMed  Google Scholar 

  21. Yu E, Khan SN (2014) Does less invasive spine surgery result in increased radiation exposure? A systematic review. Clin Orthop Relat Res 472:1738–1748. https://doi.org/10.1007/s11999-014-3503-3

    Article  PubMed  PubMed Central  Google Scholar 

  22. Ahn Y, Kim CH, Lee JH, Lee SH, Kim JS (2013) Radiation exposure to the surgeon during percutaneous endoscopic lumbar discectomy: a prospective study. Spine (Phila Pa 1976) 38:617–625. https://doi.org/10.1097/BRS.0b013e318275ca58

    Article  PubMed  Google Scholar 

  23. Murphy PH (1987) NCRP report 91: recommendations on limits for exposure to ionizing radiation. Bethesda, NCRP Publication, 1987, 72 pp, $1100 28:1929–1929

  24. National research council committee on the biological effects of ionizing R (1990) In: Health effects of exposure to low levels of ionizing radiation: Beir V (ed) national academies press (US) Copyright © 1990 by the national academy of sciences, Washington (DC)

  25. Harrison Farber S, Nayar G, Desai R, Reiser EW, Byrd SA, Chi D, Idler C, Isaacs RE (2018) Radiation exposure to the surgeon during minimally invasive spine procedures is directly estimated by patient dose. Eur Spine J 27:1911–1917. https://doi.org/10.1007/s00586-018-5653-6

    Article  CAS  PubMed  Google Scholar 

  26. Godzik J, Mastorakos GM, Nayar G, Hunter WD, Tumialan LM (2020) Surgeon and staff radiation exposure in minimally invasive spinal surgery: prospective series using a personal dosimeter. J Neurosurg Spine. https://doi.org/10.3171/2019.11.SPINE19448

    Article  PubMed  Google Scholar 

  27. Alexandre D, Prieto M, Beaumont F, Taiar R, Polidori G (2017) Wearing lead aprons in surgical operating rooms: ergonomic injuries evidenced by infrared thermography. J Surg Res 209:227–233. https://doi.org/10.1016/j.jss.2016.10.019

    Article  PubMed  Google Scholar 

  28. Rees CR, Duncan BWC (2018) Get the lead off our backs! Tech Vasc Interv Radiol 21:7–15. https://doi.org/10.1053/j.tvir.2017.12.003

    Article  PubMed  Google Scholar 

  29. Chang CC, Chang HK, Wu JC, Tu TH, Cheng H, Huang WC (2020) Comparison of radiation exposure between O-arm navigated and C-arm guided screw placement in minimally invasive transforaminal lumbar interbody fusion. World Neurosurg 139:e489–e495. https://doi.org/10.1016/j.wneu.2020.04.052

    Article  PubMed  Google Scholar 

  30. Bratschitsch G, Leitner L, Stucklschweiger G, Guss H, Sadoghi P, Puchwein P, Leithner A, Radl R (2019) Radiation exposure of patient and operating room personnel by fluoroscopy and navigation during spinal surgery. Sci Rep 9:17652. https://doi.org/10.1038/s41598-019-53472-z

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Funding

This research is supported by a grant from Korea’s Health Technology R&D Project through the Korea Health Industry Development Institute and funded by the Ministry of Health & Welfare, Republic of Korea (Grant Number: HC20C0163). The funder had no role in the design of the study or collection, analysis, interpretation of data, or writing the manuscript.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea

    Jung-Hoon Kim, Khanathip Jitpakdee, Young-Jin Kim, Cho-Rong Lee & Jin-Sung Kim

  2. Department of Orthopaedics, Queen Savang Vadhana Memorial Hospital, Thai Red Cross Society, Si Racha, Chonburi, Thailand

    Khanathip Jitpakdee

  3. Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Vit Kotheeranurak

  4. The Brain and Spine Care, Minimally Invasive Spine Surgery Group, Hospital H+, Queretaro City, Mexico

    Javier Quillo-Olvera

  5. Seoul Top Spine Hospital, Goyang-si, Gyeonggi-do, Republic of Korea

    Kyung-Chul Choi

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  1. Jung-Hoon Kim
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Corresponding author

Correspondence to Jin-Sung Kim.

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Conflict of interest

The corresponding author, Jin-Sung Kim, is a consultant of RIWOSPINE, Gmbh, Germany, Elliquence, LLC, USA. The other authors have no conflicts of interest to declare.

Ethical approvel

IRB approval was obtained from Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea (KC22RISI0919).

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Kim, JH., Jitpakdee, K., Kotheeranurak, V. et al. Is navigation beneficial for transforaminal endoscopic lumbar foraminotomy? A preliminary comparison study with fluoroscopic guidance. Eur Spine J 32, 2808–2818 (2023). https://doi.org/10.1007/s00586-023-07624-5

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  • DOI: https://doi.org/10.1007/s00586-023-07624-5

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