Determinants of intraoperative radiation during single-level tubular lumbar decompression.
- 1Steadman Philippon Research Institute, 181 W Meadow Dr. Suite 1000, Vail, CO, 81657, United States.
- 2The Steadman Clinic, 181 W Meadow Drive, Suite 1000, Vail, CO, United States.
- 3University of Virgnia Orthopaedic Center, 2280 Ivy Road, Charlottesville, VA, 22903, United States.
Abstract
Minimally invasive tubular lumbar decompression requires intraoperative fluoroscopy for retractor docking, yet dosimetry data beyond the learning curve is poorly characterized. Most studies report fluoroscopy time rather than a dose index. We identified patient- and case-level determinants of intraoperative reference air kerma (Kar) during single-level tubular lumbar decompression by a surgeon far into the surgical proficiency learning curve. About 114 consecutive patients undergoing single-level unilateral tubular lumbar decompression were retrospectively reviewed between January 2023 and January 2026. The primary outcome was fluoroscopic Kar (mGy). The influence of body mass index (BMI), operative level, age, sex, American Society of Anesthesiologists (ASA) physical status class, laterality, and concurrent discectomy was measured on univariate and multivariable analysis. Median Kar was 2.13 mGy (interquartile range [IQR] 1.28-3.50) over 4.0 seconds (IQR 3.0-6.0) of fluoroscopy. In the multivariable model BMI was the only independent predictor with a 6.9% increase per unit of BMI (1.069 per kg/m², 95% confidence interval 1.036-1.104, p = .0001). Operative level was not independently significant. Higher BMI was associated with both longer fluoroscopy time (ρ = 0.214, p = .022) and greater Kar per second (ρ = 0.388, p < .001). Secondary analysis suggested higher Kar at upper lumbar levels (L2-L3 and L3-L4) than at lower levels. BMI is the dominant determinant of intraoperative radiation during tubular lumbar decompression, acting through increased fluoroscopy time and greater C-arm power output rather than surgical complexity. These findings support preoperative radiation planning and dose-reduction strategies targeting automatic exposure control parameters.
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BibTeX
@article{garg2026determinants,
title = {{Determinants of intraoperative radiation during single-level tubular lumbar decompression.}},
author = {Sahil Garg and Christopher Franquemont and Patrick Young and Pawan Pathagamage and Arianna K Gill and Eric Piatt and Justina Lanni and Nivia Garcia and Ben LaCarte and Michael Gallizzi and Sanjitpal S Gill},
journal = {North American Spine Society journal},
year = {2026},
month = oct,
doi = {10.1016/j.xnsj.2026.100957},
url = {https://europepmc.org/article/MED/42999639},
note = {CC BY},
}
RIS
TY - JOUR
TI - Determinants of intraoperative radiation during single-level tubular lumbar decompression.
AU - Sahil Garg
AU - Christopher Franquemont
AU - Patrick Young
AU - Pawan Pathagamage
AU - Arianna K Gill
AU - Eric Piatt
AU - Justina Lanni
AU - Nivia Garcia
AU - Ben LaCarte
AU - Michael Gallizzi
AU - Sanjitpal S Gill
PY - 2026
DA - 2026/10/08
JO - North American Spine Society journal
DO - 10.1016/j.xnsj.2026.100957
UR - https://europepmc.org/article/MED/42999639
AB - Minimally invasive tubular lumbar decompression requires intraoperative fluoroscopy for retractor docking, yet dosimetry data beyond the learning curve is poorly characterized. Most studies report fluoroscopy time rather than a dose index. We identified patient- and case-level determinants of intraoperative reference air kerma (Kar) during single-level tubular lumbar decompression by a surgeon far into the surgical proficiency learning curve. About 114 consecutive patients undergoing single-level unilateral tubular lumbar decompression were retrospectively reviewed between January 2023 and January 2026. The primary outcome was fluoroscopic Kar (mGy). The influence of body mass index (BMI), operative level, age, sex, American Society of Anesthesiologists (ASA) physical status class, laterality, and concurrent discectomy was measured on univariate and multivariable analysis. Median Kar was 2.13 mGy (interquartile range [IQR] 1.28-3.50) over 4.0 seconds (IQR 3.0-6.0) of fluoroscopy. In the multivariable model BMI was the only independent predictor with a 6.9% increase per unit of BMI (1.069 per kg/m², 95% confidence interval 1.036-1.104, p = .0001). Operative level was not independently significant. Higher BMI was associated with both longer fluoroscopy time (ρ = 0.214, p = .022) and greater Kar per second (ρ = 0.388, p < .001). Secondary analysis suggested higher Kar at upper lumbar levels (L2-L3 and L3-L4) than at lower levels. BMI is the dominant determinant of intraoperative radiation during tubular lumbar decompression, acting through increased fluoroscopy time and greater C-arm power output rather than surgical complexity. These findings support preoperative radiation planning and dose-reduction strategies targeting automatic exposure control parameters.
SN - 2666-5484
ER -