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Putting a New Spin On Percutaneous Kyphoplasty: Reducing Fluoroscopy Time by Utilizing Fluoroscopic Computed Tomography and 3-Dimensional Image Reconstruction 2014

Category Interventional Mustafa Syed, DO Christopher Moran, MD Robert Hang, MD Sagar Patel Michael Carrick, B.S. RT(R)(CV) Eli Halpert, MD Purpose Kyphoplasty has been routinely done with a standard 2-D fluroscopic (biplanar) technique. As a result, it is not uncommon to have long fluoroscopic times per vertebral body level with secondarily increased radiation exposure to both the operator and patient. We use a novel method utilizing c-arm computed tomography with high-speed 3-dimensional reconstruction (3-D spin fluoroscopy) resulting in significant reduction in fluoroscopic time. Currently, there is a lack of literature exploring utilization of 3-D spin fluoroscopy in performing kyphoplasty. However, this technique becomes relevant in the current radiology climate centered around offering appropriate, cost-effective, low-radiation imaging and intervention options. Materials & Methods A total of 82 percutaneous kyphoplasties (vertebral body levels) performed by a single interventional radiologist were reveiwed retrospectively. Thirty-eight of these procedures were performed with biplane fluoroscopy, prior to the availability of 3-D spin fluoroscopy. Forty-one of these procedures were performed with 3-D spin fluoroscopy. Parameters that were analyzed included overall fluorsocopic time, fluoroscopic time required per level, number of levels per patient, mean patient age, indication for procedure, and analysis of mean difference in time and radiation exposure in patients that had percutatenous kyphoplasty with and without 3-D spin fluoroscopy. Results On average, a kyphoplasty utilizing 3-D spin fluoroscopy reduced fluoroscopic exposure by 3.63 minutes or nearly 40%. The average fluorsocopy time per level without 3-D spin fluoroscopy was 9.04 minutes. The average fluorsocopy time per level with 3-D spin fluoroscopy was 5.41 minutes. Limitations of this study include the fact that we only analyzed the case data of a single interventional radiologist. The overall fluoroscopy times are artificially increased by an initial learning curve/involvement of a fellow. Complex cases or ones that required patient repositioning also increased fluoroscopy time. Conclusion Biplane fluoroscopy is the standard technique employed in this procedures and often results in unnecessarily long fluoroscopic times. Currently, there is a lack of data in the literature with regards to utilizing 3-D spin fluoroscopy. Our findings demonstrate that utilization of 3-D spin fluoroscopy, despite its initial learning curve, offers significant reduction in fluoroscopy time and radiation exposure to both operator and patient. Given that radiology is shifting towards appropriate, low-radiation, cost effective imaging and intervention, our technique becomes very relevant to both the in- and outpatient interventional radiology practice settings. References Alan T. Villavicencio, M.D., Sigita Burneikiene, M.D., Ketan R. Bulsara, M.D., Jeffrey J. Thramann, M.D: Intraoperative Three-Dimensional Fluoroscopy-Based Computerized Tomography Guidance for Percutaneous Kyphoplasty. Neurosurg Focus. 2005;18(3)