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

Hao Qin; Li Deng; Lin Xu; Qingchun Mu; Xiang Luo; Shengbin Huang; Maosheng Wang; Chunmei Luo; Chunming Huang; Wenhua Huang

doi:10.21037/atm-21-5844

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

Ann Transl Med. 2021 Dec;9(23):1730. doi: 10.21037/atm-21-5844.

Authors

Hao Qin^#^{1

2}, Li Deng^#¹, Lin Xu^#², Qingchun Mu¹, Xiang Luo², Shengbin Huang², Maosheng Wang¹, Chunmei Luo¹, Chunming Huang¹, Wenhua Huang^{3

4}

Affiliations

¹ Clinical Research Center of Digital Medicine and 3D Printing, Affiliated Gaozhou Hospital of Guangdong Medical University, Gaozhou, China.
² Department of Orthopedics, Guigang City People's Hospital, Guigang, China.
³ Orthopedic Center, Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, China.
⁴ Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangdong Provincial Key Laboratory of Medical Biomechanics, National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China.

^# Contributed equally.

Abstract

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.

Keywords: 3D printing; C-arm navigation; learning curve; percutaneous endoscopic lumbar discectomy (PELD); radiation.