Reduced radiation exposure during O-arm navigation in degenerative lumbar spine surgery

Objectives: We aimed to compare the amount of radiation exposure that was produced during computed tomography (CT)-control versus O-arm control of pedicle screw placement during degenerative lumbar spine surgery. Patients and methods: Between November 2013 and August 2021, 358 patients (O-arm + neuronavigation) group (154 males, 204 females; mean age: 61.4±12.3 years; range, 40 to 84 years) who underwent spinal surgery were included in the study. All patients in this group underwent surgery with intraoperative O-arm CT and neuronavigation assistance. The control (fluroscopy + CT-control) group consisted of 124 patients (50 males, 74 females; mean age: 63.9±11.9 years; range, 49 to 72 years) who underwent lumbar spinal stabilization surgery for adult degenerative lumbar disease under fluoroscopy and postoperative CT-control. All data were collected retrospectively. Kolmogorov-Smirnov test was employed to test whether radiation dose values exerted an equal distribution. Following the detection that these values did not distribute equally, a Mann-Whitney test was used to test the significance. Results: Patients operated with intraoperative O-arm CT and neuronavigation assistance did not require any revision surgery. Median radiation exposure per patient was calculated as 1108.4 and 838 mGycm for control (CT-control) and study (O-arm) groups, respectively. Mann-Whitney test revealed a significant difference in reduced radiation exposure with O-arm (z: –6.056, asymptotic significance (2-tailed) p<0.0001). We detected reduced levels with O-arm surgery in terms of cumulative radiation exposure. Conclusion: We advocate the routine use of intraoperative O-arm imaging and neuronavigation particularly in degenerative spinal surgery due to both reduced radiation exposure and providing more precise screw placement.