Decreasing radiation dose with FluoroLESS Standalone Anterior Cervical Fusion

Kingsley R. Chin, Fabio J. R. Pencle, Kathleen A. Quijada, Moawiah S. Mustafa, Luai S. Mustafa, Jason A. Seale


Background: Radiation dose continues to be a concern especially in the field of spine surgery, where anterior and posterior instrumentation is frequently utilized to treat multiple pathologies. The authors aim to demonstrate the feasibility of decreasing the radiation dose in standalone anterior cervical discectomy and fusion (ACDF).
Methods: Standalone ACDF (S-ACDF) with 48 consecutive patients (Group 1) with a comparison control group with ACDF with an anterior cervical plate (ACP) of 49 patients (Group 2). Fluoroscopy was performed for positioning, identification of level, placement of the implant, each screw, final AP and lateral images for the first 20 patients in Group 1. Screw placement could then be performed confidently based on cosine rule of cosine (Ѳ) = adj/hyp.
Results: Forty-eight patients in Group 1 (S-ACDF) and 49 patients in Group 2 (ACDF-ACP). Statistical significance not demonstrated for age, BMI or gender, P=0.691, 0.947 and 0.286 respectively. Mean radiation dose in group 1 of 17.9±6.6 mAs and 0.8±0.3 mSv was significantly less compared to group 2 which was 29.8±5.4 and 1.3±0.2 mSv, P<0.001. The average radiation dose for single-level fusion in Group 1 was 12.5±3.5 mAs and 0.5±0.1 mSv this is compared to Group 2 of 27.8±3.9 mAs and 1.2±0.2 mSv, P=0.001. The average radiation dose for two level fusion in Group 1 was 22.2±5.1 mAs and 0.9±0.2 mSv this is compared to Group 2 of 33.9±6.0 and 1.4±0.3 mSv, P=0.001.
Conclusions: In the outpatient setting, S-ACDF has shown a statistically significant intergroup difference in overall radiation dose, as well as single and two-level fusions, (P<0.001). We conclude that S-ACDF can decrease overall radiation exposure to patients.