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Ultrasound-guided transforaminal percutaneous endoscopic lumbar discectomy: a new guidance method that reduces radiation doses

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Abstract

Purpose

The purpose of this study is to establish a new method to reduce the radiation dose during puncture and cannulation in percutaneous endoscopic lumbar discectomy (PELD).

Methods

Sixty patients with lumbar disk herniation undergoing PELD were prospectively enrolled and randomly divided into an ultrasound (US) guidance group and an X-ray guidance group. The puncture, cannulation, and total operation times; number of fluoroscopy shots; and radiation dose were recorded in both groups. The factors influencing the operation were analyzed. The clinical effect of PELD was evaluated using the straight leg elevation test, visual analog scale (VAS) and Oswestry disability index (ODI). The researchers who collected and analyzed the data were blinded to the group assignments.

Results

The puncture, cannulation and operation times in the US group were comparable to those in the X-ray group. The patients in the US group received 2.13 ± 0.35 fluoroscopy shots and a radiation dose of 5.34 ± 0.63 (mSV), which were significantly lower than the values in the X-ray group (7.57 shots ± 2.99 shots and 18.25 mSV ± 10.52 mSV) (P < 0.001). In the US group, the puncture time was significantly longer at the L5–S1 level, in patients with a BMI greater than 28 kg/m2 and in patients with a high iliac crest. The US and X-ray groups had comparable VAS and ODI scores 1 h and 3 months after PELD, and the VAS scores were significantly lower after PELD (all P < 0.001). No complications were observed in either group.

Conclusions

US guidance is a new method that reduces the radiation dose required during puncture and cannulation in PELD.

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Acknowledgements

This study is supported by the clinical research support fund of PLA general hospital (No. 2018XXFC-18).

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Author notes

  1. Mingbo Zhang and Longtao Yan authors contributed equally to this work and should be considered co-first authors.

Authors and Affiliations

  1. Department of Ultrasound, General Hospital of Chinese PLA, Beijing, China

    Mingbo Zhang, Shoupeng Li & Yingying Li

  2. Department of Pain, China-Japan Friendship Hospital, Beijing, China

    Longtao Yan

  3. Department of Orthopedics, General Hospital of Chinese PLA, No. 28, Fuxing Road, Haidian District, Beijing, 100853, China

    Peng Huang

Authors
  1. Mingbo Zhang
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  2. Longtao Yan
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  3. Shoupeng Li
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  4. Yingying Li
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  5. Peng Huang
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Correspondence to Peng Huang.

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Zhang, M., Yan, L., Li, S. et al. Ultrasound-guided transforaminal percutaneous endoscopic lumbar discectomy: a new guidance method that reduces radiation doses. Eur Spine J 28, 2543–2550 (2019). https://doi.org/10.1007/s00586-019-05980-9

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  • DOI: https://doi.org/10.1007/s00586-019-05980-9

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