Radiation exposure in XLIF surgery utilizing ultra-low radiation imaging with image enhancement software: a randomized controlled trial.

Abstract

Minimally invasive spine surgery has grown significantly over the last decade. Lateral approaches for interbody fusion, such as XLIF/LLIF result in higher radiation exposure for the operating room (OR) staff and the patient compared to posterior techniques. New technologies such as ultra-low radiation imaging (ULRI) combined with image enhancement (IE) software may help reduce this exposure while maintaining procedural efficacy. To evaluate whether using ULRI with IE software (mFluoro) reduces radiation exposure for OR staff and patients during lateral interbody fusion via the XLIF approach without increasing procedure time. Prospective, randomized controlled trial. The sample consists of 60 patients. Primary outcome: Radiation exposure of the OR staff, measured in microsieverts (μSv), documented by personal dosimetry centrally in front of the sternum above the lead apron. Radiation exposure of the patient, measured in cGy*cm², documented by the fluoroscopy unit's dose report; Procedure time, measured in minutes. This single-center prospective randomized controlled single-blind study included 60 patients who all underwent single-level lateral interbody fusion via XLIF approach between March, 2023 and December, 2024. Patients were randomized into two groups: intervention group (mFluoro) or control group (cFluoro). Radiation exposure of the OR staff was measured using dosimeters, and imaging parameters were extracted from the fluoroscopy unit's dose report. No significant difference was found between the two groups regarding age, gender, BMI, implant type, and diagnosis (all p>.05). The mFluoro group showed a significant reduction in radiation exposure for the OR staff: 72.1% for the surgeon (p<.001), 76.1% for the assistant (p<.001), and 67.5% for the scrub nurse (p<.001). Patient radiation exposure was also significantly reduced in the intervention group, with dose area product (DAP) values lowered by 66.1% (p<.001). Fewer images were acquired in the mFluoro group (31.3% reduction, p<.001), and procedure time was reduced by 17.7% (71.3±21.3 minutes vs. 86.6±31.5 minutes; p=.034). Using ULRI with IE software significantly reduces radiation exposure for the OR staff in single-level lateral interbody fusion via the XLIF approach. Furthermore, the radiation exposure for the patient was also significantly reduced.