Effective dose of radiation per screw in surgery of adolescent idiopathic scoliosis: Matched pair analysis of 293 pedicle screws inserted using three different techniques. (December 2020)

• Record Type: Journal Article
• Authors: Konieczny, Markus Rafael; Boos, Johannes; Steuwe, Andrea; Schleich, Christoph; Prost, Max; Krauspe, Rüdiger
• Is Part Of: Journal of children's orthopaedics. Volume 14:Number 6(2020)
• Page Start: 554
• Page End: 561
• Publication Date: 2020-12
• Subjects: adolescent idiopathic scoliosis -- navigation -- computer-assisted surgery -- effective dose -- pedicle screws; Pediatric orthopedics -- Periodicals; 618.927005
• DOI: 10.1302/1863-2548.14.200148
• Languages: English
• ISSNs: 1863-2521

Abstract

Abstract: Purpose: Reports on heterogenous groups of patients have indicated that pedicle screw insertion guided by navigation (PIN) leads to, for the patient, higher doses of radiation compared with pedicle screw insertion guided by fluoroscopy (PIF). This would be a major concern, especially in paediatric deformity correction. Methods: After a power analysis (aiming at > 0.8) 293 pedicle screws which were inserted in patients with adolescent idiopathic scoliosis were analyzed by comparing effective dose and fluoroscopy time per screw for three different techniques. Groups 2 and 3 were matched to Group 1 by Lenke type of scoliosis. Group 1 were prospectively enrolled consecutive patients that have been operated on by PIN with image acquisition by preoperative CT scan (CTS). Group 2 were consecutive retrospectively matched patients who have been operated on by PIN with image acquisition by an intraoperative 3D scan (3DS). Group 3 were consecutive retrospectively matched patients who have been operated on by PIF. Results: Mean dose of radiation per screw was 1.0 mSv (sd 0.8) per screw in CTS patients, 0.025 mSv (sd 0.001) per screw in 3DS patients and 0.781 mSv (sd 0.12) per screw in PIF patients. The difference was significant (p < 0.0001). Conclusion: When we compared different techniques of navigation, navigation by image acquisition with CTS showed a significantly higher (by 97.5%) dose of radiation per screw for the patient than navigation by image acquisition by a 3DS. Navigation by 3DS showed significantly lower effective dose per screw for the adolescent patients than the fluoroscopic technique. Level of Evidence: II