Ultrasound volume navigation technology in transforaminal puncture of minimally invasive lumbar surgery with full-endoscopic techniques

Abstract

Objective To evaluate the effectiveness of ultrasound (US) volume navigation technology in guiding the lumbar transforaminal puncture with full-endoscopic technique through posterolateral approach. Methods From June 2011 to June 2013, 60 patients (37 males and 23 females; mean age: 32.9 years) with single-level lumbar disc herniation who had undergone lumbar transforaminal puncture with full-endoscopic technique through posterolateral approach were enrolled in this retrospective study, and they were randomly divided into 2 groups according to whether the assistance of ultrasound volume navigation technology was used. They received the minimally invasive surgery on L4, 5 (47 cases) and L5S1 (13 cases). In the US-guidance group (29 cases), ultrasound volume navigation was used to guide puncture process, and in the C-arm guided group (31 cases), C-arm was applied to guide the puncture process The total puncture time and C-arm fluoroscopy times were recorded. Parameters including Oswestry disability index (ODI) and visual analogue scale (VAS) were selected to evaluate the clinical efficacy. Results Patients had no obvious discomfort during the puncture procedure and no postoperative complications. In US-guidance group, the preoperative time was 13.7±2.1 min (range, 11-16 min), and the whole process took 20.6±3.1 min (range, 16-28 min), while the average time of C-arm exposure were 4.9±0.8 times (range, 4-7 times). In C-arm guided group, the average time for puncture procedure was 27.9±1.7 min (range, 25-32 min), and the average times of C-arm exposure were 14.3±1.2 times (range, 13-17 times). There were significant differences between two groups. Compared with C-arm guided group, US-guidance group had the same accuracy rate of puncture (the puncture needles all reached the target area), but the fluoroscopy times and puncture timewere decreased significantly. There's no significant difference among the pre and postoperative ODI and VAS indexes. Patients were followed-up at 3 months and 1 year postoperation. The mean follow-up period was 16.4 months (range, 12-26 months). The ODI score of the USguidance group were 72.9%±5.9%, 17.1%±3.6% and 15.9%±3.3% before operation, 3 months postoperation and 1 year postoperation respectively. The ODI score of the C-arm guided group were 73.2%±4.9%, 17.3%±3.3% and 16.1%±2.9% respectively. The VAS were 7.4±0.9,2.2±0.7 and 1.9±0.8 in US-guidance group, and were 7.2±0.9, 2.1±0.7, 1.8±0.8 in C-arm guided group. Conclusion The ultrasound volume navigation can guide the lumbar transforaminal puncture with full-endoscopic technique through posterolateral approach accurately, reducing the puncture time and the amount of X-ray radiation significantly. Its puncture accuracy and efficacy have no significant differences, which could be broadly used in clinical application. Key words: Ultrasonography; Surgery, computer-assisted; Endoscopes