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A Systematic Review and Meta-Analysis of Radiation Exposure in Spinal Surgeries: Comparing C-Arm, Ct Navigation, and O-Arm Techniques Publisher Pubmed



Shirbache K1 ; Heidarzadeh M2 ; Qahremani R3 ; Karami A4 ; Karami S5 ; Madreseh E6 ; Jauregui JJ7 ; Najafzadeh E8, 9 ; Kazemi A10, 11 ; Nabian MH1, 12
Authors
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Authors Affiliations
  1. 1. Pediatric Orthopaedic Department, Hopital Robert Debre, Groupe Hospitalier Universitaire AP-HP Nord-Universite Paris-Cite, Paris, France
  2. 2. Medical student at Tehran University of Medical Sciences, MPH student at Tehran University of Medical Sciences, Iran
  3. 3. Tehran University of Medical Sciences, Iran
  4. 4. Department of Orthopedic Surgery, Clinical Research Development Unit of Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  5. 5. School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
  6. 6. Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
  7. 7. Spine Surgeon, Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland, United States
  8. 8. Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
  9. 9. Department of Molecular Imaging, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
  10. 10. Medical Physics and Biomedical Engineering Department, Faculty of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
  11. 11. Research Center of Biomedical Technology and Robotics (RCBTR), Advanced Medical Technologies & Equipment Institute (AMTEI), Imam Khomeini Hospital Complex, Tehran University of Medical Sciences (TUMS), Tehran, Iran
  12. 12. Center for Orthopedic Trans-Disciplinary Applied, Research (COTAR), Tehran University of Medical Sciences, Tehran, Iran

Source: Journal of Medical Imaging and Radiation Sciences Published:2025


Abstract

Introduction: Advanced imaging techniques, such as C-arm fluoroscopy, O-arm, and CT navigation, are integral to achieving precision in orthopedic surgeries. However, these technologies also expose patients, surgeons, and operating room staff to varying levels of radiation. This systematic review and meta-analysis evaluate the radiation exposure (RE) associated with these imaging modalities and their impact on surgical outcomes. Methods: A comprehensive literature search was conducted following PRISMA guidelines, resulting in 2,725 identified articles. After removing duplicates and screening for eligibility, 24 studies were included in the analysis. Radiation exposure data, measured in milliSieverts (mSv) and milliGray (mGy), were standardized using conversion formulas. Quality assessments were performed using the Newcastle-Ottawa Scale (NOS) and ROB2 tools. Statistical analysis was conducted using random-effects models for comparing radiation exposure and fixed-effects models for secondary outcomes. Results: The meta-analysis included 11 studies: 8 studies comparing C-arm and CT navigation, and 3 studies comparing C-arm and O-arm technologies. The analysis revealed that CT navigation is associated with significantly higher RE compared to C-arm (Standardized Mean Difference (SMD): 4.73, 95% Confidence Interval (CI): 2.44 to 7.03; p < 0.0001). In contrast, there was no significant difference in RE between O-arm and C-arm (SMD: 1.34, 95% CI: -0.17 to 2.85; p = 0.082). Secondary analyses showed no significant differences in surgery duration or hospitalization length between CT navigation and C-arm techniques. Discussion: The results of this meta-analysis underscore the trade-offs between radiation exposure and surgical precision. While CT navigation significantly increases RE compared to C-arm fluoroscopy, it offers superior accuracy, particularly in critical precision surgeries such as spinal interventions. The lack of significant difference in RE between O-arm and C-arm technologies suggests that O-arm may provide a balanced approach, offering enhanced accuracy with radiation levels similar to C-arm. However, the significant heterogeneity among studies and inconsistent reporting of secondary outcomes indicate the need for further research. Future studies should focus on refining imaging techniques to optimize the balance between radiation safety and surgical accuracy. Conclusion: C-arm imaging generally results in lower radiation exposure compared to CT navigation, making it preferable for standard procedures where extreme precision is not as critical. However, CT navigation's superior accuracy justifies its use in precision surgeries despite the higher radiation exposure. O-arm technology, with its comparable RE to C-arm and enhanced accuracy, represents a beneficial option where available. Ongoing research should aim to optimize imaging techniques, balancing the need for radiation safety with the demands for surgical precision. © 2024