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Topic:

Adolescent Idiopathic Scoliosis

Issue:

Spine

Category:

Developmental

Title:

Intraoperative Radiation Exposure in Adolescent Idiopathic and Neuromuscular Scoliosis

Author:

Fares, Nicole MD; Levey, Sarah Toner MD; Ashy, Cody MD; McFadden, Ryan BS; Barfield, William PhD; Murphy, Robert F. MD; Dow, Matthew A. MD; Van Nortwick, Sara S. MD

Journal:

Journal of Pediatric Orthopaedics

Date:

January 2024

Reference:

44(1): p e40-e45, DOI: 10.1097/BPO.0000000000002547

Level Of Evidence:

III

# of Patients:

148

Study Type:

Retrospective study

Location:

Single institution (likely pediatric center)

Summary:

This study evaluates variability in intraoperative radiation exposure during spinal fusions for adolescent idiopathic scoliosis (AIS) and neuromuscular scoliosis (NMS) patients.

Methods:

Inclusion Criteria: Patients with AIS or NMS aged 8-18 years who underwent posterior spinal fusion and segmental spinal instrumentation from 2017 to 2019. Exclusion Criteria: Revision surgeries, use of intraoperative navigation, and patients younger than 10 years at the time of scoliosis onset within the AIS cohort. Data Collected: Preoperative curve, body mass index (BMI), number of levels fused, number of Ponte osteotomies, and fluoroscopy time. Data Analysis: One-way analysis of variance tests Bonferroni post hoc tests Independent t-tests Pearson correlations Significance Level: 95% confidence (α = 0.05)

Exclusions:

Not specified

Results:

The average fluoroscopy time was 143 ± 67 seconds. NMS patients had significantly higher average fluoroscopy times (193 ± 75 s) compared to AIS patients (129 ± 58 s, P < 0.001). In AIS patients, fluoroscopy time correlated with preoperative curve size (r = 0.182, P = 0.050). AIS patients with fewer than 12 levels fused had significantly less radiation exposure than those with 12 or more levels fused (P = 0.01). In AIS patients, higher BMI was associated with greater fluoroscopy times (P = 0.001). In NMS patients, fluoroscopy time was negatively correlated with BMI (r = −0.459, P = 0.009) and positively correlated with preoperative curve (r = 0.475, P = 0.007).

Conclusions:

Fluoroscopy times vary greatly during adolescent spinal fusions for scoliosis. Longer fluoroscopy times are associated with NMS diagnosis, larger preoperative curve, BMI, and the number of levels fused. Increased awareness of these factors can help reduce intraoperative radiation exposure.

Relevance:

Limitations:

Perspective:

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