Inverted C-arm Orientation During Simulated Hip Arthroscopic Surgery.

BACKGROUND: Fluoroscopic guidance is routinely utilized during hip arthroscopic surgery. Previous studies have shown that the C-arm orientation can significantly affect radiation exposure for both the surgeon and the patient during orthopaedic procedures. However, this has not been previously assessed for hip arthroscopic surgery. HYPOTHESIS: Using an inverted C-arm during hip arthroscopic surgery will reduce radiation exposure to the patient and surgeon. STUDY DESIGN: Descriptive laboratory study. METHODS: A simulation study measured scatter radiation during hip arthroscopic surgery performed in the supine position under fluoroscopic guidance with an anthropomorphic pelvic phantom on a radiolucent operating table. Radiation exposure tested 2 different C-arm orientations: standard and inverted. Testing was performed at 6 locations corresponding to the patient, surgeon's neck, surgeon's waist, surgical technician, anesthesiologist, and radiology technician. Statistical analysis was performed using univariate and multivariate analyses assessing radiation exposure between the C-arm orientations. A risk calculation for carcinogenesis was performed based on reported radiation dosages. RESULTS: Radiation exposure (in mGy/min) was more than 100-fold higher for the patient compared with the surgeon in both C-arm orientations. The inverted C-arm orientation resulted in a 2.48-fold decrease in patient radiation exposure when compared with the standard orientation (10.8 mGy/min vs 26.8 mGy/min, respectively). There was a small but significant increase in surgeon radiation exposure in the inverted orientation compared with the standard orientation (0.072 vs 0.067 mGy/min, respectively). The patient's carcinogenesis risk was decreased 2.64-fold with the inverted orientation compared with the standard orientation (1.4 × 10-5 vs 3.7 × 10-5, respectively). CONCLUSION: The inverted C-arm orientation resulted in a 2.48-fold decrease in patient radiation exposure with a 2.64-fold decrease in the carcinogenesis risk compared with the standard orientation. Inadvertently, the inverted orientation provided a 9-cm increase in the surgeon's working area. Our data supported the clinical utilization of the inverted C-arm orientation during hip arthroscopic surgery to minimize patient radiation exposure. Although there was a minimal but significant increase in surgeon radiation exposure with the inverted orientation, we believe that this is negligible when incorporated with standard leaded protective equipment as contrasted with the significant dose reduction for the patient as well as the decreased risk of carcinogenesis and hereditary disorders. CLINICAL RELEVANCE: Patients undergoing hip arthroscopic surgery routinely acquire radiation exposure during the use of the C-arm. Measures to minimize radiation via the inverted C-arm orientation will decrease the unnecessary risk to the patient while continuing to allow for optimal treatment.

Preventing Construct Subsidence Following Cervical Corpectomy: The Bump-stop Technique.

Cervical corpectomy is a viable technique for the treatment of multilevel cervical spine pathology. Despite multiple advances in both surgical technique and implant technology, the rate of construct subsidence can range from 6% for single-level procedures to 71% for multilevel procedures. In this technical note, we describe a novel technique, the bump-stop technique, for cervical corpectomy. The technique positions the superior and inferior screw holes such that the vertebral bodies bisect them. This allows for fixation in the dense cortical bone of the endplate while providing a buttress to corpectomy cage subsidence. We then discuss a retrospective case review of 24 consecutive patients, who were treated using this approach, demonstrating a lower than previously reported cage subsidence rate.

Extraintestinal manifestations of inflammatory bowel disease and the influence of smoking.

AIMS: To define the number/frequency of organ systems affected by extraintestinal manifestations (EIMs), to identify factors affecting the clinical course of inflammatory bowel disease (IBD) and EIM development, and to determine the impact of smoking, disease duration and location on the diagnosis of EIMs in Crohn's disease (CD) and ulcerative colitis (UC). METHODS: IBD patients were derived from a single university colorectal surgery practice. Smoking data were obtained through a modified Behavioral Risk Factor Surveillance System survey. The frequencies of arthritis/arthralgia, primary sclerosing cholangitis (PSC), ocular and cutaneous EIMs were determined. RESULTS: Of the 757 patients evaluated (CD 488, UC 269), 50% had ≥1 EIM. Arthritis/arthralgia, cutaneous and ocular EIMs were significantly higher in frequency in CD compared to UC patients. Prolonged disease duration was associated with increased prevalence of arthritis/arthralgia in IBD (p ≤ 0.001) as well as PSC (p = 0.049), ocular (p = 0.030) and cutaneous (p = 0.009) EIMs in CD. Disease location affected the occurrence of EIMs in CD. Smoking appeared to increase the prevalence of ocular EIMs in UC (p = 0.026). CONCLUSION: Arthritis/arthralgia, cutaneous and ocular EIMs occurred in a significantly higher proportion of CD patients. CD patients with longer disease duration had a significantly higher prevalence of PSC, ocular and cutaneous EIMs. Smoking was found to increase ocular EIMs in UC.