Fan Guoxin, Wang Teng, Hu Shuo, Guan Xiaofei, Gu Xin, He Shisheng
Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, People's Republic of China.
Pain fellow, Department of Anesthesia, University of Manitoba, Winnipeg, Canada.
Pain Physician. 2017 May;20(4):E531-E540.
Accurate puncture during percutaneous transforaminal endoscopic discectomy at the L5/S1 level in cases with high iliac crest and narrow foramen were difficult, even though the difficulties of foraminoplasty could be overcome by advanced instruments like reamers.
The report aimed to describe an isocentric navigation technique with a definite pathway in difficult puncture cases at the L5/S1 level.
Technical note.
Difficult punctures were defined as over 10 punctures of the needle before obtaining an ideal puncture location by senior surgeons with experience of over 500 percutaneous endoscopic transforaminal discectomy (PETD) cases.
A total of 124 punctures were recorded in 11 difficult puncture cases at the L5/S1 level. A definite pathway was created by an isocentric navigation theory, which was based on a surface locator and an arch-guided device. The surface locator was used to rapidly and accurately identify the puncture target with the recognition of the surrounding rods under fluoroscopy. The arch-guided device can ensure that the puncture target always remains at the center of a virtual sphere. We recorded the puncture times, fluoroscopy exposure times, radiation exposure time, operative time, visual analog scale (VAS) score, Japanese Orthopeadic Association (JOA) score, and patient satisfaction.
The average puncture times were significantly reduced to 1.27 with the arch-guided device compared with conventional puncture methods (P < 0.05). The average operative time was 90.09 ± 11.00 minutes and the fluoroscopy times were 53.36 ± 5.85. The radiation exposure time was 50.91 ± 5.20 seconds. VAS score of leg and back pain, as well as JOA score, were all significantly improved after surgery (P < 0.05). The excellent and good rate of satisfaction was 90.91%. No major complications, including cerebral fluid leakage, surgical infection, and postoperative nerve root injury, were recorded in this small sample.
This was a small-sample study with a short follow-up.
The novel isocentric navigation technique with a definite pathway is practical and effective in reducing puncture times among difficult puncture cases at the L5/S1 level, which may contribute to the capacity of PETD at the L5/S1 level.
在髂嵴较高且椎间孔狭窄的病例中，经皮椎间孔镜下L5/S1节段椎间盘切除术的精确穿刺较为困难，尽管使用诸如扩孔钻等先进器械可克服椎间孔成形的困难。
本报告旨在描述一种在L5/S1节段困难穿刺病例中具有明确路径的等中心导航技术。
技术说明。
困难穿刺定义为资深外科医生（有超过500例经皮内镜下椎间孔椎间盘切除术（PETD）经验）在获得理想穿刺位置前穿刺针穿刺超过10次。
记录了11例L5/S1节段困难穿刺病例中的124次穿刺。基于表面定位器和弓状引导装置的等中心导航理论创建了明确的路径。表面定位器用于在透视下识别周围的杆从而快速准确地确定穿刺靶点。弓状引导装置可确保穿刺靶点始终位于虚拟球体的中心。我们记录了穿刺次数、透视暴露时间、辐射暴露时间、手术时间、视觉模拟评分（VAS）、日本矫形外科学会（JOA）评分以及患者满意度。
与传统穿刺方法相比，使用弓状引导装置后平均穿刺次数显著减少至1.27次（P < 0.05）。平均手术时间为90.09 ± 11.00分钟，透视次数为53.36 ± 5.85次。辐射暴露时间为50.91 ± 5.20秒。术后腿部和背部疼痛的VAS评分以及JOA评分均显著改善（P < 0.05）。满意度优良率为90.91%。在这个小样本中未记录到包括脑脊液漏、手术感染和术后神经根损伤在内的重大并发症。
这是一项随访时间短的小样本研究。
这种具有明确路径的新型等中心导航技术在减少L5/S1节段困难穿刺病例的穿刺次数方面切实有效，这可能有助于提高L5/S1节段PETD的手术能力。
