Table 2.

Studies comparing the effect on emission of radiation navigated versus nonnavigated spine operations

Study	Study design	Materials and methods	Results/conclusion
Izadpanah et al. [9]	30 navigated versus 30 conventional balloon kyphoplasties in osteoporotic fractures	Measurement of radiation time and dose are product	Radiation exposure of surgeon and patient could be reduced significantly
Kim et al. [11]	Combined human and cadaveric study, comparing minimally invasive transforaminal lumbar interbody fusion	18 cadavers, 10 patients, navigated versus conventional, compared fluoroscopy time and dose measurements	Fluoroscopy shorter for navigated operations, no emission detected for navigated, 12.4 mREM surgeon dose
Smith et al. [25]	Cadaver study comparing 3-D navigation versus conventional lumbar spinal fusion	Badge measurements above apron of surgeon	4.33 mREM torso exposure without and 0.33 mREM with navigation
Slomczykowski et al. [24]	20 cases with lumbar spinal fusion analyzed regarding duration of radiation and position of fluoroscope, comparison of CT-based navigation and fluoroscopy-assisted nonnavigated surgery	REMAB and RANDO-Phantom used, testing of CT protocols, measurement of organ and effective doses of patients	Effective doses: Fluoroscopy: 1 mS Sequential CT: 4.1 mS Spiral CT optimized: 3.0 mS Sequential CT optimized: 2.4 mS
Gebhard et al. [6]	38 patients, comparison of different types of navigation for pedicle screw placement	TLD on patient, source and receiver, spinal fusion, four screws	Lowest emission in 3-D navigation, highest in conventional fusion

TLD = thermoluminescence dosimeter.