Robot-assisted vertebral augmentation reduces radiation exposure time by 50%


A study published ahead-of-print in Spine suggests that radiation exposure time for the spinal surgeon and operating room staff during robot-assisted vertebral augmentation procedures may be 50% less than the shortest radiation exposure time documented with other navigation systems used in vertebral augmentation.

Study authors Yair Barzilay (Department of Orthopaedic Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel) and others write in Spine that spinal surgeons “strive to minimise surgical exposure and increase precision in implant placement” but add that this has led to an increased use of fluoroscopic guidance—and consequently, an increase in radiation exposure to the surgeon, the operating room staff, and the patient. They comment: “Radiation exposure is a growing concern among orthopaedic surgeons and operating room staff…the estimated cancer incidence among surgeons who perform fluoroscopically assisted percutaneous vertebroplasty is 0.025% and the estimated incidence of fatal thyroid cancer is 0.0025%; 25 times higher than the general population.” As robot-assisted spinal surgery is associated with a reduction in radiation exposure for other forms of spinal surgery, Barzilay et al sought to compare radiation exposure time during robot-assisted vertebral augmentation to published results for similar surgeries conducted under fluoroscopic guidance.

The authors performed a review of 33 consecutive patients who underwent robot-assisted (Spine Assist, Mazor Robotics) vertebral augmentation—15 underwent kyphoplasty, 13 underwent vertbroplasty, and five received an intra-vertebral expanding implant—at their centre (Hadassah Hebrew University Medical Center). The mean radiation exposure time was 34.1 seconds per augmented level for surgeons and operating staff, which is an approximate 50% reduction compared with the shortest time in published results. Barzilay et al explain: “In the literature discussing radiation exposure in vertebral body augmentation, the use of navigation systems has been shown to reduce exposure time from 175±23 seconds per level in fluoroscopy-guided procedures to 74 seconds per level under 2D imaging guidance and to 99 seconds per level under 3D imaging guidance. In the radiological literature, radiation exposure time reached was 10 minutes per level in some vertebroplasty and kyphoplasty procedures.”

In the study, the average preoperative CT effective dose was 50mSv—which, according to the authors, is “relatively high” compared with conventional CT examination of the spine. However, they note: “The CT protocol [for robot-assisted vertebral augmentation] that formed the basis of this study has been substantially revised as a result of this study. The current protocol delivers a dose that is a 75% reduction from this dose.”

Concluding their findings, Barzilay et al state: “Technical advances in CT equipment and modifications in CT protocols enable reduced radiation exposure from preoperative CT scans and may allow the use of these techniques in young otherwise healthy patients.”