Ierardi Anna Maria, Piacentino Filippo, Giorlando Francesca, Magenta Biasina Alberto, Bacuzzi Alessandro, Novario Raffaele, Carrafiello Gianpaolo
Unit of Interventional Radiology, Department of Radiology, University of Insubria, Varese, 21100, Italy.
Department of Diagnostic and Interventional Radiology, University of Milan, San Paolo Hospital, 20142, Milan, Italy.
Skeletal Radiol. 2016 Dec;45(12):1669-1676. doi: 10.1007/s00256-016-2486-4. Epub 2016 Oct 3.
To demonstrate the feasibility of percutaneous nucleoplasty procedures at L5/S1 level using cone beam CT (CBCT) and its associated image guidance technology for the treatment of lumbar disc herniation (LDH).
We retrospectively reviewed 25 cases (20 men, 5 women) of LDH at L5/S1 levels. CBCT as guidance imaging was chosen after a first unsuccessful fluoroscopy attempt that was related to complex anatomy (n = 15), rapid pathological changes due to degenerative diseases (n = 7) or both (n = 3). Technical success, defined as correct needle positioning in the target LDH, and safety were evaluated; overall procedure time and radiation dose were registered. A visual analog scale (VAS) was used to evaluate pain and discomfort pre-intervention after 1 week and 1, 3, and 6 months after the procedure.
Technical success was 100 %; using CBCT as guidance imaging the needle was correctly positioned at the first attempt in 20 out of 25 patients. Neither major nor minor complications were registered during or after the procedure. The average procedure time was 11 min and 56 s (range, 9-15 min), whereas mean procedural radiation dose was 46.25 Gy.cm (range 38.10-52.84 Gy.cm), and mean fluoroscopy time was 5 min 34 s (range 3 min 40 s to 6 min 55 s). The VAS pain score decreased significantly from 7.6 preoperatively to 3.9 at 1 week, 2.8 at 1 month, 2.1 at 3 months, and 1.6 at 6 months postoperatively.
CBCT-guided percutaneous nucleoplasty is a highly effective technique for LDH with acceptable procedure time and radiation dose.
探讨使用锥形束CT（CBCT）及其相关图像引导技术在L5/S1水平进行经皮髓核成形术治疗腰椎间盘突出症（LDH）的可行性。
回顾性分析25例L5/S1水平的LDH患者（男20例，女5例）。在首次透视尝试因解剖结构复杂（n = 15）、退行性疾病导致的快速病理变化（n = 7）或两者皆有（n = 3）而失败后，选择CBCT作为引导成像。评估技术成功率（定义为针在目标LDH中的正确定位）和安全性；记录总体手术时间和辐射剂量。使用视觉模拟量表（VAS）评估术前、术后1周、1、3和6个月的疼痛和不适情况。
技术成功率为100%；使用CBCT作为引导成像，25例患者中有20例在首次尝试时针就正确定位。术中及术后均未出现严重或轻微并发症。平均手术时间为11分56秒（范围9 - 15分钟），而平均手术辐射剂量为46.25 Gy.cm（范围38.10 - 52.84 Gy.cm），平均透视时间为5分34秒（范围3分40秒至6分55秒）。VAS疼痛评分从术前的7.6显著降低至术后1周的3.9、1个月时的2.8、3个月时的2.1和6个月时的1.6。
CBCT引导下的经皮髓核成形术是治疗LDH的一种高效技术，手术时间和辐射剂量均可接受。
