Ultrasound guidance for transforaminal percutaneous endoscopic lumbar discectomy may prevent radiation exposure: A case report

Abstract

BACKGROUND Percutaneous endoscopic lumbar discectomy (PELD) has become a mature and mainstream minimally invasive surgical technique for treating lumbar disc herniation (LDH). Repeated fluoroscopy, with more than 30 shots on average, is inevitable to ensure its accuracy and safety. However, exposure to X-rays may pose a threat to human health. We herein report a case of ultrasound (US)-assisted PELD in two levels of LDH to explore a new possibility that can reduce the radiation dose during puncture and cannulation in PELD. CASE SUMMARY A 38-year-old man with low back pain and left leg pain for more than 7 years came to our clinic, his symptoms had aggravated for 1 month, and he was diagnosed with L3-4 and L4-5 disc herniations. He received US-guided PELD with good results: His straight leg elevation increased from 40 to 90 degrees after PELD, and his visual analog scale (VAS) and Oswestry Disability Index scores both significantly decreased immediately and 6 mo after PELD. With the guidance of US, he received only two shots of fluoroscopy (fluoroscopic time: 4.4 s; radiation dose: 3.98 mGy). To our knowledge, this is the first case of US-guided puncture and cannulation of PELD for LDH at two levels. CONCLUSION US could be used to guide PELD and has the potential to largely reduce radiation than traditional X-ray guidance.

Neurological safety of spinal surgery for nucleus pulposus removal under spinal endoscopic imaging guided by inter laminar spine

“…14,15 Lumbar Oswestry disability index (ODI) is used to score lumbar function and pain, and the higher the OSI score, the more severe the lumbar dysfunction of patients. [16][17][18][19] The results showed that VAS and ODI scores were significantly lower than before treatment, which indicated that the pain and lumbar function of patients with disc herniation were significantly improved after the use of spinal endoscopic nucleus pulposus extraction, which was basically consistent with the research results of Zhang et al 20 Follow-up results showed that there were no perioperative complications such as infection and nerve root injury. In short, the endoscopic resection of the nucleus pulposus for the treatment of disc herniation has excellent neurological safety and is worthy of clinical adoption.…”

Ultrasound-guided Nusinersen Administration for Spinal Muscular Atrophy Patients With Severe Scoliosis: a Retrospective Single-arm Cohort Study

“…However,successful use of ultrasound assistance or real-time guidance to facilitate a di cult interlaminar lumbar puncture for other purposes in patients with spinal fusion instrumentation [21,26,34] has been reported previously. Similarly, the transforaminal lumbar injection technique, which has been used under CT guidance for intrathecal access in patients with spinal fusion where a interlaminar approach is often not possible, has also been reported to be successfully performed with ultrasound guidance in other circumstances [35,36]. Therefore, the value of ultrasound guidance in SMA patients with spinal fusion is worthy of attention and exploration.…”

Value of ultrasound-guided transforaminal nerve block in the treatment of lumbar disc herniation

“…Disc herniation is one of the most common causes of lumbar and leg pain, which can restrict the patient's mobility. 1,2 In severe cases, people are unable to care for themselves in daily life. The most common types of disc herniation are L3/4 and L4/5 herniations.…”