Radiation exposure reduction in ultrasound-guided transforaminal percutaneous endoscopic lumbar discectomy for lumbar disc herniation: a randomized, controlled trial.

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Radiation exposure reduction in ultrasound-guided transforaminal percutaneous endoscopic lumbar discectomy for lumbar disc herniation: a randomized, controlled trial.

World Neurosurg. 2019 Jan 12;:

Authors: Wu RH, Deng DH, Huang XQ, Shi CL, Liao XQ

Abstract
BACKGROUND: Transforaminal percutaneous endoscopic lumbar discectomy (TF-PELD) is a minimally invasive technique with high radiation exposure. The purpose of this study was to compare radiation exposure of ultrasound-guided TF-PELD with fluoroscopy-guided TF-PELD.
METHODS: In this prospective randomized controlled clinical trial, 60 patients with lumbar disc herniation were enrolled and randomly assigned to two groups (30 cases in each group): ultrasound-guided group or fluoroscopy-guided group. The radiation exposure, fluoroscopy time and visual analog scale score were recorded. Meanwhile, the number of possible operations per year within the yearly occupational exposure limit (OEL) were calculated. We also recorded the adverse events to evaluate the safety of ultrasound-guided TF-PELD.
RESULTS: In 30 patients from ultrasound-guided group, the lumbar disc structure were clearly visible under ultrasound guidance. The effective dose to surgeons and radiation dose to patients was 1.7±0.4 and 25.2±4.9 μSv in the ultrasound-guided group, and 9.0±2.5 and 127.4±27.1 μSv in fluoroscopy-guided group (p<0.05), respectively. The fluoroscopy time was 2.6± 0.5 s in the ultrasound-guided group and 127.3±29.5 s in the fluoroscopy-guided group (p<0.05). A surgeon with shielding devices could perform 5,556 cases per year in the fluoroscopy-guided group before exceeding the OEL for the whole-body radiation, while 29,412 cases in the ultrasound-guided group. No difference between groups was detected in postoperative VAS score (p>0.58). No serious adverse event was found in all patients.
CONCLUSION: Ultrasound-guided TF-PELD could decrease radiation exposure to surgeons and patients, without serious adverse events. It seems to be an acceptable alternative to fluoroscopy-guided TF-PELD.

PMID: 30648611 [PubMed - as supplied by publisher]

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