Comparison of Radiation Exposure of the Surgeon in Minimally Invasive Treatment of Osteoporotic Vertebral Fractures – Radiofrequency Kyphoplasty versus Balloon Kyphoplasty with Cement Delivery Systems (CDS)

Abstract

The aim of the present study was to compare the radiation exposure of the surgeon when using two different kyphoplasty systems for the minimally invasive treatment of osteoporotic vertebral body fractures. There was a preliminary investigation study by a Belgian working group from the ORAMED project (2010), which served as the basis and showed a dose reduction for the surgeon when using a balloon kyphoplasty system with cement delivery systems (CDS).

Materials and Methods A bipedicular balloon kyphoplasty system (Medtronic GmbH) with CDS and a unipedicular radiofrequency kyphoplasty system (StabiliT, DFine Europe GmbH) were used in solitary fractures in the thoracolumbar junction in 20 patients each. The patient groups were relatively homogeneous with a mean age of 76.9 years for balloon kyphoplasty and 75 years for radiofrequency kyphoplasty. As expected, the proportion of woman was higher in both groups. The mean BMI value was higher in the radiofrequency kyphoplasty group, and the patient with the highest BMI was also in this group. The workflows were defined in three steps. The working time and the fluoroscopic time were measured in the individual work steps and the dose was measured over all work steps by TLD chips (thermoluminescence detector) on the forehead, on the X-ray apron, on both wrists and on the left ankle. The dose area product was registered for the entire procedure.

Results In step 2, the main differences were found in working time and fluoroscopy time in transit. The difference was due to the bipedicular puncture for balloon kyphoplasty and the change of the working cannula, while only a unipedicular puncture was needed in radiofrequency kyphoplasty. The total fluoroscopy time over all procedures was three times longer than in balloon kyphoplasty and this was also reflected in the dose area product, which was more than twice that. The measured surface doses for the lenses were four times higher in balloon kyphoplasty. For the left wrist, the values for balloon kyphoplasty were about 8 times higher.

Conclusion Overall, from a radiophysical perspective, the use of a unipedicular kyphoplasty system must be recommended. Should balloon kyphoplasty be used for medical reasons, all radiation protection products (lead gloves, lead glass, radiation protection goggles and CDS) should be used, the surface doses for both hands must be detected by a ring dosimeter and the lens dose must be recorded and documented by a TLD on the radiation protection goggles.

Key Points:

• Unipedicular kyphoplasty systems would be the better options for radiation protection reasons.

• Specific medical indications may justify the use of a bipedicular kyphoplasty system on a case-by-case basis.

• The use of a ballon kyphoplasty system without CDS is no longer recommended.

• When using a bipendicular kyphoplasty system, the surface doses for the hands and the lens must be documented.

Citation Format

• Reißberg S, Lüdeke L, Fritsch M. Comparison of Radiation Exposure of the Surgeon in Minimally Invasive Treatment of Osteoporotic Vertebral Fractures – Radiofrequency Kyphoplasty versus Balloon Kyphoplasty with Cement Delivery Systems (CDS). Fortschr Röntgenstr 2020; 192: 59 – 64

Key words

kyphoplasty - radiation safety - technical aspects - spine

• References

• 1 Yu E, Khan SN. Does less invasive spine surgery result in increased radiation exposure? A systematic review. Clin Orthop Relat Res 2014; 472: 1738-1748
• 2 Drees P, Kafchitsas K, Mattyasovszky S. et al. Die Radiofrequenz-Kyphoplastie – Eine innovative Methode zur Behandlung von osteoporotischen Wirbelkörperkompressionsfrakturen. J Miner Soffwechs 2010; 17 (Sonderheft: 15-19
• 3 Schlaich C, Minne HW, Bruckner T. et al. Reduced pulmonary function in patients with spinal osteoporotic fractures. Osteoporosis Int 1998; 8: 261-267
• 4 Gold DT. The clinical impact of vertebral fractures: quality of life in woman with osteoporosis. Bone 1996; 18: 185-189
• 5 Silverman SI, Minshall ME, Shen W. et al. The relationship of health-related quality of life to prevalent and incident vertebral fractures in postmenopausal woman with osteoporosis: results from the Multiple Outcomes of Raloxifene Evaluation Study. Arthritis Rheum 2001; 44: 2611-2619
• 6 Kado DM, Browner WS, Palermo L. et al. Vertebral fractures and mortality in older woman: aprospective study. Arch Intern Med 1999; 159: 1215-1220
• 7 Struelens L, Krim S, Vanhavere F. Extremity Doses of Medical Staff for Complex Interventional Procedures and in Nuclear Medicine ExDos. Final report 2010.
• 8 Li YY, Huang TJ, Cheng CC. et al. Comparing radiation exposure during percutaneus vertebroplasty using one- vs. two-fluoroscopic technique. BMC Musculoskeletal Disorders 2013; 14: 38 . doi:10.1186/1471-2474-14-38
• 9 Schils F, Schoojans W, Struelens L. The surgeon’s real dose exposure during ballon kyphoplasty procedure and evaluation oft he cement delivery system: a prospective study. Eur Spine J 2013; 22: 1758-1764 . doi:10.1007/s00586-013-2702-z
• 10 Zhang GQ, Gao YZ, Chen SL. et al. Significantly reduced radiation dose to operators during percutaneous vertebroplasty using a new cement delivery device. BMC Musculoskeletal Disorders 2014; 15: 260-266 . doi:10.1186/1471-2474-15-260
• 11 Libischer M, Knoch T, Keuler A. et al. Ortsdosismessung während der Kyphoplastie – Vorschläge zur Reduktion der Strahlendosis von Operateur und OP-Personal. Fortschr Röntgenstr 2005; 177 – VO_4109 DOI: 10.1055/s-2005-867860.
• 12 Schütz U, Beer M, Wild A. et al. Strahlenschutz bei C-Bogen-gestützten Wirbelsäulenprozeduren in Orthopädie und Unfallchirurgie. OUP 2016; 4: 224-237 . doi:10.3238/oup.2016.0224-237