Guide-Needle Angle and Sleeve Placement Evaluation on Skin Entry in Percutaneous Endoscopy Lumbar Discectomy Procedure Based on Three-dimensional Computed Tomography

Abstract

Background: Low back pain and sciatic pain are some of the most common and infuriating pains. The prevalences are about 18-29%. The minimally invasive technique of spine decompression offers several advantages. One of the methods is percutaneous endoscopic lumbar discectomy (PELD) using the transforaminal approach. This study aimed to evaluate the needle angle and sleeve placement based on skin entry point using 3-dimensional (3D) computed tomography morphometric measurements. Methods: The data were collected using 3D computed tomography morphometric measurements on the 4th – 5th lumbar. The parameters comprised several aspects of the vertebral morphometry. The vertebral AP length, spinous to skin length, AP vertebral body length, 30% of vertebral body length, and angle of the needle insertion data were collected. All the data were then analyzed using SPSS. Results: There were 50 patients enrolled in this study. From vertebral morphometry, the average angle for the needle insertion for 4th lumbar spine in the coronal plane was 48.224 (± 4.138)°. The average distance of the needle insertion was 8.185 (±1.709) cm. The average twice the distance of the needle insertion was 16.370 (±3.417) cm and the average angle with the length doubled was 22.268 (±0.953)°. The average angle for 4th lumbar in the sagittal plane was 78.169 (±1.445)°. Conclusion: We found the angle in the coronal plane for PELD in the 4th vertebra lumbar was 48.224°. The angle of insertion was 22.268° when the distance was doubled. The angle in the sagittal plane for PELD in the 4th lumbar spine was 78.169°.