Radiation Exposure to the Surgeon During Ultrasound-Assisted Transforaminal Percutaneous Endoscopic Lumbar Discectomy: A Prospective Study.

Abstract

To determine the radiation dose to the surgeon during ultrasound-assisted transforaminal percutaneous endoscopic lumbar discectomy (PELD) for lumbar disc herniation, and to investigate whether the usage of ultrasonography could reduce the radiation exposure to the surgeon. The stages of needle insertion and foraminal plasty for transforaminal PELD were performed under ultrasound guidance and confirmed by fluoroscopy according to the standard technique by 2 spinal surgeons separately in 25 transforaminal PELDs (25 levels). The radiation exposure dose of the surgeons' chest above and below the shielding and the fluoroscopy time were recorded. The effective dose and number of possible levels per year within the yearly occupational exposure limit (OEL) were calculated. The radiation dose per level and fluoroscopy time between ultrasound-assisted PELD and fluoroscopy-assisted PELD were compared. The mean operation time and fluoroscopy time were 67.6 ± 14.6 minutes and 2.9 ± 0.7 seconds, respectively. The mean effective dose to the surgeons per level was 1.3 ± 0.6 μSv. One surgeon could perform PELDs at 38,462 levels per year without exceeding the OEL for whole-body radiation wearing a lead apron, and 1938 levels per year without using any shielding devices. Ultrasound-assisted PELD had significantly less radiation dose per level at the chest below and above apron, effective dose per level, and fluoroscopy time, compared with fluoroscopy-assisted PELD (all P < 0.05). The method of ultrasound-assisted needle insertion and foraminal plasty in transforaminal PELD can reduce radiation exposure to the surgeons compared with fluoroscopy-assisted PELD.