Application of a New Body Surface-assisting Puncture Device in Percutaneous Transforaminal Endoscopic Lumbar Discectomy

Overview

Journal BMC Musculoskelet Disord

Publisher Biomed Central

Specialties Orthopedics
Physiology

Date 2022 Dec 5

PMID 36471305

Authors

Xincheng Fan

Qiting He

Chaofan Yi

Wei Zhao

Derui Xu

Guoqing Peng

Feng Liu

Lei Cheng

Affiliations

Soon will be listed here.

Abstract

Background: Accurate puncture and localization are critical for percutaneous transforaminal endoscopic lumbar discectomy surgery. However, several punctures are often required, followed by X-ray fluoroscopy, which can increase surgical risk and complications. The aim of this study was to demonstrate a new body surface-assisting puncture device that can be used in percutaneous transforaminal endoscopic lumbar discectomy and to assess its clinical effectiveness.

Methods: Three hundred and forty-four patients were treated with percutaneous transforaminal endoscopic lumbar discectomy surgery in the Spinal Surgery Department of Taian City Central Hospital, China, between January 2020 and February 2022. Of these, 162 patients (the locator group) were punctured using a body surface-assisting puncture device while and 182 patients (the control group) were punctured using the traditional blind puncture method. The number of punctures, radiation dose during X-ray fluoroscopy, operation time, and surgical complications were compared between the two groups.

Results: The average number of punctures was 2.15 ± 1.10 in the locator group which was significantly lower than that in the control group (5.30 ± 1.74; P < 0.001). The average X-ray fluoroscopy radiation dose in the locator group was significantly lower at 2.34 ± 0.99 mGy, compared with 5.13 ± 1.29 mGy in the control group (P < 0.001). The mean operation time was also significantly less in locator group (47.06 ± 5.12 vs. 62.47 ± 5.44 min; P = 0.008). No significant differences in surgical complications were found between the two groups (P > 0.05).

Conclusion: The use of a new body surface-assisting puncture device in percutaneous transforaminal endoscopic lumbar discectomy surgery can significantly reduce the number of punctures and X-ray fluoroscopy radiation dose, as well as shortening the operation time, without increasing surgical complications. This device is cheap, easy to operate, and suitable for all hospitals and spine surgeons, especially for small hospitals, with also no extra costs for patients.

Citing Articles

Utilization of a novel patient-specific 3D-printing template for percutaneous endoscopic transforaminal discectomy: results from a randomized controlled trial.

Huang X, Luo Q, Liang C, Wang Y, Jia D, Li S Front Neurosci. 2024; 18:1323262.

PMID: 38680448 PMC: 11047121. DOI: 10.3389/fnins.2024.1323262.

References

Carragee E, Han M, Suen P, Kim D . Clinical outcomes after lumbar discectomy for sciatica: the effects of fragment type and anular competence. J Bone Joint Surg Am. 2003; 85(1):102-8. View

Ahn Y . Endoscopic spine discectomy: indications and outcomes. Int Orthop. 2019; 43(4):909-916. DOI: 10.1007/s00264-018-04283-w. View

Kanno H, Aizawa T, Hahimoto K, Itoi E . Minimally invasive discectomy for lumbar disc herniation: current concepts, surgical techniques, and outcomes. Int Orthop. 2019; 43(4):917-922. DOI: 10.1007/s00264-018-4256-5. View

Lv Z, Jin L, Wang K, Chen Z, Li F, Zhang Y . Comparison of Effects of PELD and Fenestration in the Treatment of Geriatric Lumbar Lateral Recess Stenosis. Clin Interv Aging. 2020; 14:2187-2194. PMC: 6924588. DOI: 10.2147/CIA.S226295. View

Feng W, Yang J, Wei D, Gong H, Xi Y, Lv H . Gradient local anesthesia for percutaneous endoscopic interlaminar discectomy at the L5/S1 level: a feasibility study. J Orthop Surg Res. 2020; 15(1):413. PMC: 7493882. DOI: 10.1186/s13018-020-01939-5. View

Little M, Azizova T, Hamada N . Low- and moderate-dose non-cancer effects of ionizing radiation in directly exposed individuals, especially circulatory and ocular diseases: a review of the epidemiology. Int J Radiat Biol. 2021; 97(6):782-803. PMC: 10656152. DOI: 10.1080/09553002.2021.1876955. View

Srinivasan D, Than K, Wang A, La Marca F, Wang P, Schermerhorn T . Radiation safety and spine surgery: systematic review of exposure limits and methods to minimize radiation exposure. World Neurosurg. 2014; 82(6):1337-43. DOI: 10.1016/j.wneu.2014.07.041. View

Pan M, Li Q, Li S, Mao H, Meng B, Zhou F . Percutaneous Endoscopic Lumbar Discectomy: Indications and Complications. Pain Physician. 2020; 23(1):49-56. View

Lee D, Lee S . Learning curve for percutaneous endoscopic lumbar discectomy. Neurol Med Chir (Tokyo). 2008; 48(9):383-8. DOI: 10.2176/nmc.48.383. View

10.

Fan G, Feng C, Yin B, Guan X, Fan Y, Zhu Y . Concentric Stereotactic Technique of Percutaneous Endoscopic Transforaminal Discectomy and Radiation Exposure to Surgeons. World Neurosurg. 2018; 119:e1021-e1028. DOI: 10.1016/j.wneu.2018.08.051. View

11.

Eun S, Lee S, Sabal L . Long-term Follow-up Results of Percutaneous Endoscopic Lumbar Discectomy. Pain Physician. 2016; 19(8):E1161-E1166. View

12.

Ahn Y, Kim C, Lee J, Lee S, Kim J . Radiation exposure to the surgeon during percutaneous endoscopic lumbar discectomy: a prospective study. Spine (Phila Pa 1976). 2012; 38(7):617-25. DOI: 10.1097/BRS.0b013e318275ca58. View

13.

Ao S, Wu J, Tang Y, Zhang C, Li J, Zheng W . Percutaneous Endoscopic Lumbar Discectomy Assisted by O-Arm-Based Navigation Improves the Learning Curve. Biomed Res Int. 2019; 2019:6509409. PMC: 6348841. DOI: 10.1155/2019/6509409. View

14.

Hsu H, Chang S, Yang S, Chai C . Learning curve of full-endoscopic lumbar discectomy. Eur Spine J. 2012; 22(4):727-33. PMC: 3631049. DOI: 10.1007/s00586-012-2540-4. View

15.

Wang H, Huang B, Li C, Zhang Z, Wang J, Zheng W . Learning curve for percutaneous endoscopic lumbar discectomy depending on the surgeon's training level of minimally invasive spine surgery. Clin Neurol Neurosurg. 2013; 115(10):1987-91. DOI: 10.1016/j.clineuro.2013.06.008. View

16.

Zhou C, Zhang G, Panchal R, Ren X, Xiang H, Xuexiao M . Unique Complications of Percutaneous Endoscopic Lumbar Discectomy and Percutaneous Endoscopic Interlaminar Discectomy. Pain Physician. 2018; 21(2):E105-E112. View

17.

Albert J . Radiation risk from CT: implications for cancer screening. AJR Am J Roentgenol. 2013; 201(1):W81-7. DOI: 10.2214/AJR.12.9226. View

18.

Hadelsberg U, Harel R . Hazards of Ionizing Radiation and its Impact on Spine Surgery. World Neurosurg. 2016; 92:353-359. DOI: 10.1016/j.wneu.2016.05.025. View

19.

Fan G, Guan X, Zhang H, Wu X, Gu X, Gu G . Significant Improvement of Puncture Accuracy and Fluoroscopy Reduction in Percutaneous Transforaminal Endoscopic Discectomy With Novel Lumbar Location System: Preliminary Report of Prospective Hello Study. Medicine (Baltimore). 2015; 94(49):e2189. PMC: 5008493. DOI: 10.1097/MD.0000000000002189. View

20.

Hirano Y, Mizuno J, Takeda M, Itoh Y, Matsuoka H, Watanabe K . Percutaneous endoscopic lumbar discectomy - early clinical experience. Neurol Med Chir (Tokyo). 2012; 52(9):625-30. DOI: 10.2176/nmc.52.625. View