Fluoroscopy-Guided Spine Surgery

Fluoroscopy is real-time X-ray. During spine surgery a C-shaped X-ray machine (a "C-arm") is positioned around the area being operated on and can take live images at the press of a pedal, showing the bones and any instruments or implants on a screen. It is the long-established, widely available workhorse for confirming the correct level of the spine, guiding needles and instruments to the right place, and checking the position of screws and implants. It underpins everything from injections to minimally invasive and endoscopic surgery.

• Almost all spinal procedures use fluoroscopy at some stage, from injections to fusions
• Particularly central to minimally invasive and endoscopic surgery, where the target cannot be seen directly at first
• Its extent of use depends on the procedure

• The C-arm sits over the patient and produces two-dimensional live X-ray images from the front and, by rotating, from the side. The surgeon uses these images to identify the exact vertebra, to guide a needle or dilator to the target, and to check the trajectory and final position of screws or implants. Because it is real-time, the surgeon can watch an instrument advance and adjust as they go. Staff wear lead protection and use techniques to keep the radiation dose as low as reasonably possible.

• Real-time confirmation of the correct level and of instrument and implant position
• Widely available, reliable and familiar to every spine surgeon and theatre team
• Essential for guiding keyhole and percutaneous techniques to the target
• Lower up-front complexity and cost than full 3D navigation

• Involves ionising radiation to the patient and, cumulatively, to the surgical team, so exposure is kept as low as reasonably possible
• Provides two-dimensional images only, unlike the 3D picture of navigation systems
• For very complex trajectories, 3D navigation may add accuracy that fluoroscopy alone cannot

• O-arm or intraoperative CT navigation for 3D guidance
• Electromagnetic navigation, which can reduce the amount of live X-ray needed
• Loop-X and other mobile imaging systems

Fluoroscopy does not affect recovery, which depends on the procedure performed. It is a guidance tool that helps the surgery be done accurately and safely. Where appropriate, newer navigation methods can supplement or reduce reliance on it.

• —Royal College of Radiologists — iRefer: Making the Best Use of Clinical Radiology
• —UK Health Security Agency — Ionising Radiation: Patient Dose Information
• —British Association of Spine Surgeons (BASS)

This information is for general patient education and is not a substitute for an individual consultation. Always seek personalised advice from a qualified spinal specialist.