Significant Improvement of Puncture Accuracy and Fluoroscopy Reduction in Percutaneous Transforaminal Endoscopic Discectomy With Novel Lumbar Location System: Preliminary Report of Prospective Hello Study

Abstract

Prospective nonrandomized control study.The study aimed to investigate the implication of the HE's Lumbar LOcation (HELLO) system in improving the puncture accuracy and reducing fluoroscopy in percutaneous transforaminal endoscopic discectomy (PTED).Percutaneous transforaminal endoscopic discectomy is one of the most popular minimally invasive spine surgeries that heavily depend on repeated fluoroscopy. Increased fluoroscopy will induce higher radiation exposure to surgeons and patients. Accurate puncture in PTED can be achieved by accurate preoperative location and definite trajectory.The HELLO system mainly consists of self-made surface locator and puncture-assisted device. The surface locator was used to identify the exact puncture target and the puncture-assisted device was used to optimize the puncture trajectory. Patients who had single L4/5 or L5/S1 lumbar intervertebral disc herniation and underwent PTED were included the study. Patients receiving the HELLO system were assigned in Group A, and those taking conventional method were assigned in Group B. Study primary endpoint was puncture times and fluoroscopic times, and the secondary endpoint was location time and operation time.A total of 62 patients who received PTED were included in this study. The average age was 45.35 ± 8.70 years in Group A and 46.61 ± 7.84 years in Group B (P = 0.552). There were no significant differences in gender, body mass index, conservative time, and surgical segment between the 2 groups (P > 0.05). The puncture times were 1.19 ± 0.48 in Group A and 6.03 ± 1.87 in Group B (P < 0.001). The fluoroscopic times were 14.03 ± 2.54 in Group A and 25.19 ± 4.28 in Group B (P < 0.001). The preoperative location time was 4.67 ± 1.41 minutes in Group A and 6.98 ± 0.94 minutes in Group B (P < 0.001). The operation time was 79.42 ± 10.15 minutes in Group A and 89.65 ± 14.06 minutes in Group B (P = 0.002). The hospital stay was 2.77 ± 0.95 days in Group A and 2.87 ± 1.02 days in Group B (P = 0.702). There were no significant differences in the complication rate between the 2 groups (P = 0.386).The highlight of HELLO system is accurate preoperative location and definite trajectory. This preliminary report indicated that the HELLO system significantly improves the puncture accuracy of PTED and reduces the fluoroscopic times, preoperative location time, as well as operation time. (ChiCTR-ICR-15006730).

FIGURE 1

HE's Lumbar lpcation system consisting of surface locator and puncture-guided device. A = real picture of surface locator, B = real picture of puncture-guided device, C = the theory of puncture-guided device.

FIGURE 2

The usage of surface locator in percutaneous transforaminal endoscopic discectomy. A = attachment of surface locator to the back and the lateral skin, B = anteroposterior fluoroscopy of surface locator, C = lateral fluoroscopy of surface locator, D = identifying the puncture target on the film, E = marking the puncture target on the skin, F = drawing the entry point and planned trajectory.

FIGURE 3

The usage of puncture-guided device in percutaneous transforaminal endoscopic discectomy. A = post-sterilization of puncture-guided device, B = positioning the infrared ray to the back and lateral markers, C = rotating the arc to an appropriate angle, D = regulating the slider and locking it, E = positioning the needle guider to the entry point, F = inserting the needle through the needle guider.

FIGURE 4

Flow chart of included patients undergoing percutaneous transforaminal endoscopic discectomy in the study.

FIGURE 5

Ideal position of needle by 1 puncture and successful removal of herniated disc. A = anteroposterior fluoroscopy at L4/5, B = lateral fluoroscopy at L4/5, C = anteroposterior fluoroscopy at L5/S1, D = lateral fluoroscopy at L5/S1, E = preoperative magnetic resonance imaging of lumbar disc herniation, F = postoperative magnetic resonance imaging confirming the removal of herniated disc.