Real-time ultrasonography–magnetic resonance image fusion navigation for percutaneous transforaminal endoscopic discectomy

View More View Less
  • 1 Departments of Spine Surgery,
  • 2 Ultrasound, and
  • 3 Radiology, The Third Affiliated Hospital of Sun Yat-sen University;
  • 4 Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University;
  • 5 Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery; and
  • 6 Guangdong Key Laboratory of Liver Research, Guangzhou, China
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

OBJECTIVE

Percutaneous transforaminal endoscopic discectomy (PTED) is usually performed under fluoroscopic guidance and is associated with a large radiation dose. Ultrasonography (US)–MR image fusion navigation combines the advantages of US and MRI and requires significantly less radiation than fluoroscopy. The purpose of this study was to evaluate the safety and effectiveness of US-MR image fusion navigation for PTED.

METHODS

From January to September 2018, patients with L4–5 lumbar disc herniation requiring PTED were randomized to have the procedure conducted with US-MR image fusion navigation or fluoroscopy. The number of fluoroscopies, radiation dose, duration of imaging guidance, intraoperative visual analog scale (VAS) pain score, intraoperative complications, and clinical outcomes were compared between the groups.

RESULTS

There were 10 patients in the US-MR navigation group and 10 in the fluoroscopy group, and there were no significant differences in age, sex ratio, or BMI between the 2 groups (all p > 0.05). Intraoperatively, the total radiation dose, number of fluoroscopies performed, duration of image guidance, and VAS low-back and leg pain scores were all significantly lower in the US-MRI navigation group than in the fluoroscopy group (all p < 0.05). There were no intraoperative complications in either group. Postoperative improvements in Japanese Orthopaedic Association, Oswestry Disability Index, and VAS pain scale scores were similar between the 2 groups.

CONCLUSIONS

US-MR image fusion navigation is a promising technology for performing PTED and requires significantly less radiation than fluoroscopy.

Clinical trial registration no.: NCT03403244 (ClinicalTrials.gov).

ABBREVIATIONS JOA = Japanese Orthopaedic Association; LDH = lumbar disc herniation; NTIP = needle tail intelligent positioning; ODI = Oswestry Disability Index; PTED = percutaneous transforaminal endoscopic discectomy; US = ultrasonography; VAS = visual analog scale.

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence Limin Rong: The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. ronglm21@163.com.

INCLUDE WHEN CITING Published online March 27, 2020; DOI: 10.3171/2020.1.SPINE191223.

P.X. and F.F. contributed equally to this work.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Abu-Zidan FM, Hefny AF, Corr P: Clinical ultrasound physics. J Emerg Trauma Shock 4:501503, 2011

  • 2

    Chen Z, Zhang L, Dong J, Xie P, Liu B, Wang Q, : Percutaneous transforaminal endoscopic discectomy compared with microendoscopic discectomy for lumbar disc herniation: 1-year results of an ongoing randomized controlled trial. J Neurosurg Spine 28:300310, 2018

    • Search Google Scholar
    • Export Citation
  • 3

    Choi I, Ahn JO, So WS, Lee SJ, Choi IJ, Kim H: Exiting root injury in transforaminal endoscopic discectomy: preoperative image considerations for safety. Eur Spine J 22:24812487, 2013

    • Search Google Scholar
    • Export Citation
  • 4

    Fairbank JC, Pynsent PB: The Oswestry Disability Index. Spine (Phila Pa 1976) 25:29402952, 2000

  • 5

    Falavigna A, Ramos MB, Iutaka AS, Menezes CM, Emmerich J, Taboada N, : Knowledge and attitude regarding radiation exposure among spine surgeons in Latin America. World Neurosurg 112:e823e829, 2018

    • Search Google Scholar
    • Export Citation
  • 6

    Gibson JN, Waddell G: Surgical interventions for lumbar disc prolapse: updated Cochrane Review. Spine (Phila Pa 1976) 32:17351747, 2007

    • Search Google Scholar
    • Export Citation
  • 7

    Hakime A, Deschamps F, De Carvalho EG, Teriitehau C, Auperin A, De Baere T: Clinical evaluation of spatial accuracy of a fusion imaging technique combining previously acquired computed tomography and real-time ultrasound for imaging of liver metastases. Cardiovasc Intervent Radiol 34:338344, 2011

    • Search Google Scholar
    • Export Citation
  • 8

    He L, Kang Z, Tang WJ, Rong LM: A MRI study of lumbar plexus with respect to the lateral transpsoas approach to the lumbar spine. Eur Spine J 24:25382545, 2015

    • Search Google Scholar
    • Export Citation
  • 9

    Hsu HT, Chang SJ, Yang SS, Chai CL: Learning curve of full-endoscopic lumbar discectomy. Eur Spine J 22:727733, 2013

  • 10

    Iprenburg M, Wagner R, Godschalx A, Telfeian AE: Patient radiation exposure during transforaminal lumbar endoscopic spine surgery: a prospective study. Neurosurg Focus 40(2):E7, 2016

    • Search Google Scholar
    • Export Citation
  • 11

    Klauser AS, De Zordo T, Feuchtner GM, Djedovic G, Weiler RB, Faschingbauer R, : Fusion of real-time US with CT images to guide sacroiliac joint injection in vitro and in vivo. Radiology 256:547553, 2010

    • Search Google Scholar
    • Export Citation
  • 12

    Lee DY, Lee SH: Learning curve for percutaneous endoscopic lumbar discectomy. Neurol Med Chir (Tokyo) 48:383389, 2008

  • 13

    Li K, Su ZZ, Xu EJ, Ju JX, Meng XC, Zheng RQ: Improvement of ablative margins by the intraoperative use of CEUS-CT/MR image fusion in hepatocellular carcinoma. BMC Cancer 16:277, 2016

    • Search Google Scholar
    • Export Citation
  • 14

    Liu YB, Wang Y, Chen ZQ, Li J, Chen W, Wang CF, : Volume navigation with fusion of real-time ultrasound and CT images to guide posterolateral transforaminal puncture in percutaneous endoscopic lumbar discectomy. Pain Physician 21:E265E278, 2018

    • Search Google Scholar
    • Export Citation
  • 15

    Mills RJ, Renfrew S: Measurement of pain threshold by thermal contact. Lancet 1:738739, 1971

  • 16

    Ohtori S, Ito T, Yamashita M, Murata Y, Morinaga T, Hirayama J, : Evaluation of low back pain using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire for lumbar spinal disease in a multicenter study: differences in scores based on age, sex, and type of disease. J Orthop Sci 15:8691, 2010

    • Search Google Scholar
    • Export Citation
  • 17

    Prada F, Del Bene M, Mattei L, Lodigiani L, DeBeni S, Kolev V, : Preoperative magnetic resonance and intraoperative ultrasound fusion imaging for real-time neuronavigation in brain tumor surgery. Ultraschall Med 36:174186, 2015

    • Search Google Scholar
    • Export Citation
  • 18

    Puech P, Rouvière O, Renard-Penna R, Villers A, Devos P, Colombel M, : Prostate cancer diagnosis: multiparametric MR-targeted biopsy with cognitive and transrectal US-MR fusion guidance versus systematic biopsy—prospective multicenter study. Radiology 268:461469, 2013

    • Search Google Scholar
    • Export Citation
  • 19

    Sartoris R, Orlandi D, Corazza A, Sconfienza LM, Arcidiacono A, Bernardi SP, : In vivo feasibility of real-time MR-US fusion imaging lumbar facet joint injections. J Ultrasound 20:2331, 2017

    • Search Google Scholar
    • Export Citation
  • 20

    Siddiqui MM, George AK, Rubin R, Rais-Bahrami S, Parnes HL, Merino MJ, : Efficiency of prostate cancer diagnosis by MR/ultrasound fusion-guided biopsy vs standard extended-sextant biopsy for MR-visible lesions. J Natl Cancer Inst 108:djw039, 2016

    • Search Google Scholar
    • Export Citation
  • 21

    Theologis AA, Burch S: Safety and efficacy of reconstruction of complex cervical spine pathology using pedicle screws inserted with stealth navigation and 3D image-guided (O-Arm) technology. Spine (Phila Pa 1976) 40:13971406, 2015

    • Search Google Scholar
    • Export Citation
  • 22

    Wagner LK, Eifel PJ, Geise RA: Potential biological effects following high X-ray dose interventional procedures. J Vasc Interv Radiol 5:7184, 1994

    • Search Google Scholar
    • Export Citation
  • 23

    Zhong-Zhen S, Kai L, Rong-Qin Z, Er-Jiao X, Ting Z, Ao-Hua Z, : A feasibility study for determining ablative margin with 3D-CEUS-CT/MR image fusion after radiofrequency ablation of hepatocellular carcinoma. Ultraschall Med 33:E250E255, 2012

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 60 60 60
Full Text Views 18 18 18
PDF Downloads 15 15 15
EPUB Downloads 0 0 0