Zhang MB, Yan LT, Li SP, Li YY, Huang P. Ultrasound guidance for transforaminal percutaneous endoscopic lumbar discectomy may prevent radiation exposure: A case report. World J Clin Cases 2019; 7(10): 1161-1168 [PMID: 31183348 DOI: 10.12998/wjcc.v7.i10.1161]
Corresponding Author of This Article
Peng Huang, MD, Associate Professor, Department of Orthopedics, General Hospital of Chinese PLA, No. 28, Fuxing Road, Haidian District, Beijing 100853, China. harryhp@vip.sina.com
Research Domain of This Article
Medicine, Research & Experimental
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Ming-Bo Zhang, Shou-Peng Li, Ying-Ying Li, Department of Ultrasound, General Hospital of Chinese PLA, Beijing 100853, China
Long-Tao Yan, Department of Pain, China-Japan Friendship Hospital, Beijing 100029, China
Peng Huang, Department of Orthopedics, General Hospital of Chinese PLA, Beijing 100853, China
Author contributions: Zhang MB and Yan LT contributed equally to this work and should be considered co-first authors; Zhang MB and Yan LT reviewed the literature, performed the ultrasound-assisted transforaminal percutaneous endoscopic lumbar discectomy, and contributed to manuscript drafting; Li SP and Li YY reviewed the literature and contributed to data collection; Huang P was responsible for establishment of ultrasound guidance method and the revision of the manuscript; all authors issued final approval for the version to be submitted.
Supported byClinical Research Support Fund of PLA General Hospital, No. 2018XXFC-18.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Peng Huang, MD, Associate Professor, Department of Orthopedics, General Hospital of Chinese PLA, No. 28, Fuxing Road, Haidian District, Beijing 100853, China. harryhp@vip.sina.com
Telephone: +86-10-66875503
Received: January 13, 2019 Peer-review started: January 14, 2019 First decision: January 30, 2019 Revised: March 1, 2019 Accepted: March 16, 2019 Article in press: March 16, 2019 Published online: May 26, 2019 Processing time: 135 Days and 1.7 Hours
Abstract
BACKGROUND
Percutaneous endoscopic lumbar discectomy (PELD) has become a mature and mainstream minimally invasive surgical technique for treating lumbar disc herniation (LDH). Repeated fluoroscopy, with more than 30 shots on average, is inevitable to ensure its accuracy and safety. However, exposure to X-rays may pose a threat to human health. We herein report a case of ultrasound (US)-assisted PELD in two levels of LDH to explore a new possibility that can reduce the radiation dose during puncture and cannulation in PELD.
CASE SUMMARY
A 38-year-old man with low back pain and left leg pain for more than 7 years came to our clinic, his symptoms had aggravated for 1 month, and he was diagnosed with L3-4 and L4-5 disc herniations. He received US-guided PELD with good results: His straight leg elevation increased from 40 to 90 degrees after PELD, and his visual analog scale (VAS) and Oswestry Disability Index scores both significantly decreased immediately and 6 mo after PELD. With the guidance of US, he received only two shots of fluoroscopy (fluoroscopic time: 4.4 s; radiation dose: 3.98 mGy). To our knowledge, this is the first case of US-guided puncture and cannulation of PELD for LDH at two levels.
CONCLUSION
US could be used to guide PELD and has the potential to largely reduce radiation than traditional X-ray guidance.
Core tip: Percutaneous endoscopic lumbar discectomy, a mature and mainstream minimally invasive surgical technique for treating lumbar disc herniation (LDH), needs more than 30 shots of fluoroscopy each level on average, causing a threat to human health. With the help of ultrasound (US) guidance, we report a patient with two levels of LDH who received only two shots to achieve satisfactory results. US guidance has great potential to become an alternative method to reduce radiation largely.
