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Puncture and localization for percutaneous endoscopic lumbar discectomy with C-arm navigation: a randomized controlled cadaver trial

BACKGROUND: Accurate preoperative puncture and localization is a key step in percutaneous endoscopic lumbar discectomy (PELD). This study investigated the benefit of puncture and localization for PELD by C-arm navigation over conventional methods. METHODS: Sixteen adult cadavers were randomly divide...

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Autores principales: Qin, Hao, Deng, Li, Xu, Lin, Mu, Qingchun, Luo, Xiang, Huang, Shengbin, Wang, Maosheng, Luo, Chunmei, Huang, Chunming, Huang, Wenhua
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8743699/
https://www.ncbi.nlm.nih.gov/pubmed/35071424
http://dx.doi.org/10.21037/atm-21-5844
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author Qin, Hao
Deng, Li
Xu, Lin
Mu, Qingchun
Luo, Xiang
Huang, Shengbin
Wang, Maosheng
Luo, Chunmei
Huang, Chunming
Huang, Wenhua
author_facet Qin, Hao
Deng, Li
Xu, Lin
Mu, Qingchun
Luo, Xiang
Huang, Shengbin
Wang, Maosheng
Luo, Chunmei
Huang, Chunming
Huang, Wenhua
author_sort Qin, Hao
collection PubMed
description BACKGROUND: Accurate preoperative puncture and localization is a key step in percutaneous endoscopic lumbar discectomy (PELD). This study investigated the benefit of puncture and localization for PELD by C-arm navigation over conventional methods. METHODS: Sixteen adult cadavers were randomly divided into two groups (group A defined as the C-arm navigation method, and group B defined as the conventional localization method). Two junior orthopedic surgeons who specialized in spinal surgeries were randomly allocated to each group. Conventional localization using C-arm fluoroscopy and localization using C-arm navigation were performed during the procedure. The intervertebral foramen on both sides at L3-L4, L4-L5, and L5-S1 levels were punctured using the two methods. Technical parameters, such as fluoroscopy time, puncture time, overall time taken for puncture and localization, as well as the number of fluoroscopies, number of puncture attempts, and success rate of the first puncture were compared between the two methods. The learning curves were plotted for the two methods, and correlations between all technical parameters were analyzed. RESULTS: Puncture and localization for PELD assisted by C-arm navigation had a flatter learning curve compared with the conventional localization method. The fluoroscopy, puncture, and total puncture-localization time for group A were 5.61 (±1.37), 2.29 (±1.22), and 9.78 (±2.66) minutes compared with 15.72 (±3.59), 4.87 (±1.70), and 20.59 (±4.79) minutes for group B, respectively (P<0.05). Fluoroscopy was used on average 5.15 (±1.34) times in group A and 20.04 (±5.05) times in group B (P<0.05). There was an average of 1.08 (±0.28) puncture attempts in group A compared with 4.67 (±1.88) attempts in group B (P<0.05). The success rate of the first puncture was 91.7% in group A and 10.4% in group B (P<0.05). CONCLUSIONS: Puncture and localization using C-arm navigation for PELD was shown to dramatically flatten the learning curve of junior surgeons and significantly improved the success rate of the first puncture. Moreover, PELD using C-arm navigation can minimize surgery time and the risk of radiation exposure for both patients and medical staff by reducing the number of fluoroscopies and puncture attempts.
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spelling pubmed-87436992022-01-21 Puncture and localization for percutaneous endoscopic lumbar discectomy with C-arm navigation: a randomized controlled cadaver trial Qin, Hao Deng, Li Xu, Lin Mu, Qingchun Luo, Xiang Huang, Shengbin Wang, Maosheng Luo, Chunmei Huang, Chunming Huang, Wenhua Ann Transl Med Original Article BACKGROUND: Accurate preoperative puncture and localization is a key step in percutaneous endoscopic lumbar discectomy (PELD). This study investigated the benefit of puncture and localization for PELD by C-arm navigation over conventional methods. METHODS: Sixteen adult cadavers were randomly divided into two groups (group A defined as the C-arm navigation method, and group B defined as the conventional localization method). Two junior orthopedic surgeons who specialized in spinal surgeries were randomly allocated to each group. Conventional localization using C-arm fluoroscopy and localization using C-arm navigation were performed during the procedure. The intervertebral foramen on both sides at L3-L4, L4-L5, and L5-S1 levels were punctured using the two methods. Technical parameters, such as fluoroscopy time, puncture time, overall time taken for puncture and localization, as well as the number of fluoroscopies, number of puncture attempts, and success rate of the first puncture were compared between the two methods. The learning curves were plotted for the two methods, and correlations between all technical parameters were analyzed. RESULTS: Puncture and localization for PELD assisted by C-arm navigation had a flatter learning curve compared with the conventional localization method. The fluoroscopy, puncture, and total puncture-localization time for group A were 5.61 (±1.37), 2.29 (±1.22), and 9.78 (±2.66) minutes compared with 15.72 (±3.59), 4.87 (±1.70), and 20.59 (±4.79) minutes for group B, respectively (P<0.05). Fluoroscopy was used on average 5.15 (±1.34) times in group A and 20.04 (±5.05) times in group B (P<0.05). There was an average of 1.08 (±0.28) puncture attempts in group A compared with 4.67 (±1.88) attempts in group B (P<0.05). The success rate of the first puncture was 91.7% in group A and 10.4% in group B (P<0.05). CONCLUSIONS: Puncture and localization using C-arm navigation for PELD was shown to dramatically flatten the learning curve of junior surgeons and significantly improved the success rate of the first puncture. Moreover, PELD using C-arm navigation can minimize surgery time and the risk of radiation exposure for both patients and medical staff by reducing the number of fluoroscopies and puncture attempts. AME Publishing Company 2021-12 /pmc/articles/PMC8743699/ /pubmed/35071424 http://dx.doi.org/10.21037/atm-21-5844 Text en 2021 Annals of Translational Medicine. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Original Article
Qin, Hao
Deng, Li
Xu, Lin
Mu, Qingchun
Luo, Xiang
Huang, Shengbin
Wang, Maosheng
Luo, Chunmei
Huang, Chunming
Huang, Wenhua
Puncture and localization for percutaneous endoscopic lumbar discectomy with C-arm navigation: a randomized controlled cadaver trial
title Puncture and localization for percutaneous endoscopic lumbar discectomy with C-arm navigation: a randomized controlled cadaver trial
title_full Puncture and localization for percutaneous endoscopic lumbar discectomy with C-arm navigation: a randomized controlled cadaver trial
title_fullStr Puncture and localization for percutaneous endoscopic lumbar discectomy with C-arm navigation: a randomized controlled cadaver trial
title_full_unstemmed Puncture and localization for percutaneous endoscopic lumbar discectomy with C-arm navigation: a randomized controlled cadaver trial
title_short Puncture and localization for percutaneous endoscopic lumbar discectomy with C-arm navigation: a randomized controlled cadaver trial
title_sort puncture and localization for percutaneous endoscopic lumbar discectomy with c-arm navigation: a randomized controlled cadaver trial
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8743699/
https://www.ncbi.nlm.nih.gov/pubmed/35071424
http://dx.doi.org/10.21037/atm-21-5844
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