Radiation Exposure in Minimally Invasive Cervical Spine Surgery: A Systematic Review

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Abstract
Background and Objectives: Minimally invasive cervical spine surgery (MIS-CSS) re-lies heavily on intraoperative fluoroscopic imaging, raising concerns about radiation exposure to patients and surgical staff. Unlike lumbar MIS, cervical-specific radiation exposure has not been systematically reviewed, despite distinct anatomical considera-tions including proximity to the thyroid gland and lens of the eye. This review aims to quantify intraoperative radiation exposure during MIS cervical spine procedures and evaluate available dose-reduction strategies. Materials and Methods: A systematic literature search was conducted across Pub-Med/MEDLINE, Scopus, and Google Scholar in April 2026 following PRISMA 2020 guidelines. Studies reporting original quantitative radiation data during minimally invasive cervical spine procedures in adult patients (≥10 patients) were included. Quality was assessed using the MINORS tool and JBI checklist. Results: Seven studies encompassing 380 patients were included. Procedures com-prised ACDF (four studies), minimally invasive posterior cervical laminoforaminotomy (two studies), and CT-navigated cervical instrumentation (one study). Patient effective doses during ACDF ranged from 0.015 to 1.3 mSv, with thyroid doses of 0.194–0.290 mGy. Standalone ACDF reduced patient dose by 36–58% compared to plated ACDF (p < 0.001). Navigation-assisted posterior cervical foraminotomy achieved a median fluoroscopy time of 10 seconds with negligible staff exposure. Surgeon per-procedure exposure during cervical discectomy (chest 0.122 µSv, lens 3.1 µSv, hands 7.1 µSv) was approximately half that of lumbar discectomy. Conclusions: Radiation doses during individual MIS cervical procedures are generally within occupational safety limits; however, cumulative exposure warrants attention in high-volume surgeons. Standalone implant designs and intraoperative navigation represent effective, complementary dose-reduction strategies. Standardized prospec-tive research is needed to establish cervical-specific radiation safety benchmarks.
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