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

Background context: 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.

Purpose: 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.

Study design: Prospective, randomized controlled trial.

Patient sample: The sample consists of 60 patients.

Outcome measures: 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.

Secondary outcomes: Radiation exposure of the patient, measured in cGy*cm², documented by the fluoroscopy unit's dose report; Procedure time, measured in minutes.

Methods: 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.

Results: 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).

Conclusion: 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.