Incidencia de la exposición a los rayos X en cirugías de columna. [Incidence of X-rays exposure in spinal surgeries.]

Pedro Luis Bazán, Roberto Muscia, Joaquin Gomez Cano, Jossy Corrales Pinto, Álvaro Enrique Borri, Martín Medina, Nicolás Maximiliano Ciccioli

Resumen


Introducción: El control radioscópico intraoperatorio es una práctica cada vez más frecuente, que no está libre de eventos adversos para el personal de la salud.

Objetivos: Conocer la tasa de uso de radioscopia en la cirugía vertebral, reconocer las medidas de control, evaluar la asimilación del cirujano a los elementos de protección y analizar los eventos adversos en estos profesionales.

Materiales y Métodos: Se envió, por correo electrónico, a cirujanos espinales, una encuesta de 17 preguntas de opciones múltiples.

Resultados: Se recibieron 55 encuestas. El 87% se dedicaba a la columna, en más del 60% de sus prácticas. El arco en C es el método más utilizado para el control final, en forma pulsátil. Solo el 31% controla el tiempo real. El delantal plomado de una pieza es el método más utilizado, pero se desconoce cuándo se debe reemplazar. La mitad utiliza más de un elemento. Siete casos de trastornos visuales, 5 patologías tiroideas, 3 dermatitis y 2 casos de infertilidad. Tres cirujanos fueron operados por nódulos tiroideos, cataratas o neoplasia.

Conclusiones: El control radioscópico intraoperatorio es una práctica frecuente en la cirugía espinal. El delantal plomado de una pieza es el método más utilizado y, muchas veces, se lo combina, pero se desconoce cuándo se deben renovar los plomados. Uno de cada tres cirujanos presentaron las patologías evaluadas y 3, cirugías relacionadas. Así queda en evidencia la protección y el control escasos que existen en los cirujanos especialistas, acompañados de una falta de protocolización que deja a la deriva este control.

 

Abstract


Background: Intraoperative radiographic control (IRC) is an increasingly common practice, but it causes certain adverse events for healthcare providers.

Objectives: To measure the use of fluoroscopy in spinal surgery, recognize control measures, evaluate assimilation of protection elements by surgeons, and analyze adverse events for spinal surgeons.

Materials and Methods: A survey of 17 multiple-choice questions was e-mailed to spinal surgeons.

Results: 55 surveys were answered. More than 60% of surgeons were spinal surgeons. The C-arm is the most widely used machine for final control by pulsating X-rays. Real-time controls are carried out in 31% of cases. One-piece leaded aprons are the most commonly used method, but it is unknown when they should be replaced. Half of the respondents uses more than one protection element. There were seven cases of vision changes, 5 of thyroid disorders, 3 of dermatitis, and 2 of infertility. Three surgeons required surgery for thyroid nodules, cataracts or neoplasm.

Conclusions: IRC is a common practice in spinal surgery. One-piece leaded aprons are the most commonly used method and they are often combined with other elements, but it is not known when aprons must be replaced. One in 3 surgeons suffered from the studied conditions, and there were 3 related surgeries. Lack of adequate protection and control is a reality for specialist surgeons, together with a lack of protocols, making this an unregulated issue.

 


Palabras clave


Cirugía espinal, radioscopia, evento adverso, complicaciones, protección. Spinal surgery; fluoroscopy; adverse event; complications; protection.

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Referencias


Reiser EW, Desai R, Byrd SA, Farber H, Chi D, Idler CS, et al. C-arm positioning is a significant source of radiation in spine surgery. Spine 2017;42(9):707-10. https://doi.org/10.1097/BRS.0000000000001869

Mastrangelo G, Fedeli U, Fadda E, Giovanazzi A, Scoizzato L, Saia B. Increased cancer risk among surgeons in an orthopaedic hospital. Occupational Medicine 2005;55:498-500. https://doi/org/10.1093/occmed/kqi048

Frazier TH, Richardson JB, Fabre VC, Callen JP. Fluoroscopy-induced chronic radiation skin injury. A disease perhaps often overlooked. Arch Dermatol 2007;143(5):637-40. https://doi.org/10.1001/archderm.143.5.637

Vanoli F, Gentile L, Iglesias SL, Lobos Centeno E, Diaz MP, Allende Nores C. Exposición a la radiación de los cirujanos en la fijación interna de fracturas de radio distal. Rev Asoc Argent Ortop Traumatol 2017;82(4):271-7. http://dx.doi.org/10.15417/674

El Tecle NE, El Ahmadieh TY, Patel BM, Lall RR, Bendok BR, Smith ZA. Minimizing radiation exposure in minimally invasive spine surgery. Neurosurg Clin North Am 2014;25:247-60. http://dx.doi.org/10.1016/j.nec.2013.12.004

Chang LA, Miller DL, Lee Ch, Melo DR, Villoing D, Drozdovitch V, et al. Thyroid radiation dose to patients from diagnostic radiology procedures over eight decades: 1930-2010. Health Phys 2017;113(6):458-73. https://doi.org/ 10.1097/HP.0000000000000723

Kim TT, Johnson JP, Pashman R, Drazin D. Clinical study minimally invasive spinal surgery with intraoperative image-guided navigation. Biomed Res Int 2016. http://dx.doi.org/10.1155/2016/5716235

Karami V, Zabihzadeh M. Beam collimation during lumbar spine radiography: a retrospective study. J Biomed Phys Eng 2017;7(2):101-6.

Chou LB, Chandran S, Harris AH, Tung J, Butler LM. Increased breast cancer prevalence among female orthopedic surgeon. J Women Health (Larchmt) 2012;21(6):683-9. https://doi.org/10.1089/jwh.2011.3342

Klingler J-H, Sircar R, Scheiwe C, Kogias E, Krüger MT, Scholz C, et al. Comparative study of C-arms for intraoperative 3-dimensional imaging and navigation in minimally invasive spine surgery Part II: Radiation exposure. Clin Spine Surg 2017;30(6):E669-E676. https://doi.org/10.1097/BSD.0000000000000187

Li X, Zhang Y, Zhang Q, Zhao C, Liu K. Clinical application of a drill guide template for pedicle screw placement in severe scoliosis. Acta Ortop Bras 2017;25(2):67-70. https://doi.org/ 10.1590/1413-785220172502138828

Zhang W, Li H, Zhou Y, Wang J, Chu T, Zheng W, et al. Minimally invasive posterior decompression combined with percutaneous pedicle screw fixation for the treatment of thoracolumbar fractures with neurological deficits. Spine (Phila PA 1976) 2016;41(Suppl 19):B23-B29. https://doi.org/10.1097/BRS.0000000000001814

Wu R, Liao X, Xia H. Radiation exposure to the surgeon during ultrasound-assisted transforaminal percutaneous endoscopic lumbar discectomy: a prospective study. World Neurosurg 2017;101:658-665. https://doi.org/10.1016/j.wneu.2017.03.050

Nascimento A, Defino H, Silva M, Araújo J, Ronaldo LF. Comparison of exposure to radiation during percutaneous transpedicular procedures, using three fluoroscopic techniques. Coluna/Columna 2017;16(2):141-4. http://dx.doi.org/10.1590/s1808-185120171602178378

Li J, Lin J, Xu J, Meng H, Su N, Fan Z, et al. Novel approach for percutaneous vertebroplasty based on preoperative CT-based 3-Dimensional model design. World Neurosurg 2017;105:20-6. https://doi.org/10.1016/j.wneu.2017.05.087

Kraus M, von dem Berge PM, Krischak G, Weckbach S. Accuracy of screw placement and radiation dose in navigated dorsal instrumentation of the cervical spine: a prospective cohort study. Int J Med Robot 2014;10(2):223-9. https://doi.org/10.1002/rcs.1555




DOI: http://dx.doi.org/10.15417/issn.1852-7434.2019.84.3.884

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URL de la licencia: http://creativecommons.org/licenses/by-nc-sa/4.0/deed.es

Registro de la Propiedad Intelectual Nº 22171081 (en línea).

ISSN 1852-7434 (en línea).

Esta Revista está bajo una Licencia Creative Commons Atribución-NoComercial-Compartir Obras Derivadas Igual 4.0 Internacional. (CC-BY-NC-SA 4.0)