Intraoperative navigation increases the projected lifetime cancer risk in patients undergoing surgery for adolescent idiopathic scoliosis

• Published in: The spine journal 2024-06, Vol.24 (6), p.1087-1094
• Main Authors: Striano, Brendan M., Crawford, Alexander M., Verhofste, Bram P., Hresko, Andrew M., Hedequist, Daniel J., Schoenfeld, Andrew J., Simpson, Andrew K.
• Format: Article
• Language: English
• Subjects: Adolescent; Adolescent idiopathic scoliosis; AIS; Cancer; Child; Cross-Sectional Studies; Female; Humans; Male; Navigation; Neoplasms, Radiation-Induced - epidemiology; Neoplasms, Radiation-Induced - etiology; Radiation Dosage; Radiation exposure; Radiation Exposure - adverse effects; Retrospective Studies; Scoliosis - surgery; Spinal Fusion - adverse effects; Spinal Fusion - methods; Surgery, Computer-Assisted - adverse effects; Surgery, Computer-Assisted - methods; Tomography, X-Ray Computed
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2024.01.007

Adolescent idiopathic scoliosis (AIS) is a common condition, often requiring surgical correction. Computed tomography (CT) based navigation technologies, which rely on ionizing radiation, are increasingly being utilized for surgical treatment. Although this population is highly vulnerable to radiation, given their age and female predominance, there is little available information elucidating modeled iatrogenic cancer risk. To model lifetime cancer risk associated with the use of intraoperative CT-based navigation for surgical treatment of AIS. This retrospective cross-sectional study took place in a quaternary care academic pediatric hospital in the United States. Adolescents aged 10–18 who underwent posterior spinal fusion for a diagnosis of AIS between July 2014 and December 2019. Effective radiation dose and projected lifetime cancer risk associated with intraoperative doses of ionizing radiation. Clinical and radiographic parameters were abstracted, including total radiation dose during surgery from flat plate radiographs, fluoroscopy, and intraoperative CT scans. Multivariable regression analysis was used to assess differences in radiation exposure between patients treated with conventional radiography versus intraoperative navigation. Radiation exposure was translated into lifetime cancer risk using well-established algorithms. In total, 245 patients were included, 119 of whom were treated with navigation. The cohort was 82.9% female and 14.4 years of age. The median radiation exposure (in millisieverts, mSv) for fluoroscopy, radiography, and navigation was 0.05, 4.14, and 8.19 mSv, respectively. When accounting for clinical and radiographic differences, patients treated with intraoperative navigation received 8.18 mSv more radiation (95%CI: 7.22–9.15, p