Novel targeted puncture technique for percutaneous transforaminal endoscopic lumbar discectomy reduces X-ray exposure

Abstract

The present study explored a method to reduce X-ray exposure dose and avoid targeted puncture complications in percutaneous transforaminal endoscopic lumbar discectomy (PTELD). A total of 66 patients with lumbar disc herniation were divided into two groups for a controlled study. In the experimental group, 31 patients were subjected to PTELD using a novel targeted puncture technique with application of a lumbar disc herniation target collimator. The remaining 35 patients in the control group were subjected to free-hand targeted puncture PTELD. The number of X-ray fluoroscopies performed intraoperatively, targeted puncture accuracy, visual analogue scale for surgical pain and Oswestry disability index of the two groups were statistically analyzed. The experimental and control groups exhibited a statistically significant difference in the number of X-ray fluoroscopies required during the procedure (P<0.01). The number of successful first targeted punctures was 27 (87.1%) in the experimental group and three (8.6%) in the control group, indicating that the puncture accuracy was higher in the experimental group than in the control group. As for the pain response to outer sleeve insertion (local anesthetic injection through the guide sleeve), the experimental group had 25 mild cases (80.6%), five moderate cases (16.1%) and one severe care (3.2%), whereas the control group had five mild cases (14.3%), 19 moderate cases (54.3%) and 11 severe cases (31.4%). These results demonstrated that the overall pain response of the experimental group was milder than that of control group. Due to a larger puncture deviation, the nerve root was touched by the puncture needle in 12 cases in the control group and resulted in one case of severe postoperative infection. In conclusion, the novel targeted puncture technique guided by a lumbar disc herniation target collimator outlined in the present study is able to markedly reduce X-ray exposure dose in PTELD and limit the surgical risk and pain experienced by patients. Mastering this novel puncture technique may aid those new to performing PTELD.

Lumbar disc reherniation after transforaminal lumbar endoscopic discectomy

“…The recurrent disc herniation rate experienced in this study is similar to other studies in the literature which have reported reherniation rates of 6-12.5% after TELD (22,23). Some recent studies assessing the transforaminal endoscopic technique have reported reherniation rates as low as a 0.5% (16,24). This study attempts to analyze characteristics of patients who had experienced recurrent disc herniations after TELD.…”

“…The surgical procedure of transforaminal endoscopic lumbar decompression (TELD) has the benefits of an ultraminimally invasive spine surgery including small incision, faster recovery, less need for pain medications, and lower blood loss while still achieving equally effective pain reduction compared to traditional open surgical techniques (11)(12)(13)(14)(15). TELD does not affect spinal stability and forms minimal scar adhesions (13,16). This technique has gained increasing popularity as patient demand for more minimally invasive approaches has grown.…”

Risk Factors Involved in the Early and Medium-Term Poor Outcomes of Percutaneous Endoscopic Transforaminal Discectomy: A Single-Center Experience

“…6,18,19 This is likely due to the associated reduced muscle injury and bleeding, diminished scar formation in the spinal canal, and relatively short hospital stay. [5][6][7][8]20,21 In total, 148 cases of LDH, who were treated with PETD, were analyzed in this study. The VAS and ODI scores of all patients improved significantly at each follow-up, compared to the preoperative values (Table 1).…”

“…[2][3][4] The main advantages of PELD include local anesthesia, minimal tissue destruction, favorable outcomes, rapid recovery, and minimal invasion. [5][6][7][8] Although prior investigations revealed that PELD achieves satisfactory clinical efficacy, 2,[4][5][6][7][8] literature reports and our own experiences revealed that a small number of patients still suffer from pain and disability after PELD, and some patients even require secondary surgery. [9][10][11][12] The Sang study reported that following PELD, 9.6% patients undergo revision surgery on the same segment, and 26.6% undergo revision surgery on other segments.…”

Coaxial radiography guided puncture technique for percutaneous transforaminal endoscopic lumbar discectomy: A randomized control trial

“…Despite its numerous advantages, PELD is technically challenging and has a steep learning curve[ 11 , 12 ]. Accurate puncturing and working channel intubation are required to create favorable conditions for endoscopic surgery[ 13 , 14 ]. However, the puncture technique is relatively difficult, especially in percutaneous transforaminal endoscopic lumbar discectomy (PTELD), which requires specific puncture angles to certain parts of the intervertebral foramen.…”