Real-time Ultrasound Volume Navigation Guided Transforaminal Percutaneous Endoscopic Lumbar Discectomy in Anatomic Variation: A Case Report

doi:10.37015/AUDT.2019.191232

Abstract

Abstract:

Percutaneous endoscopic lumbar discectomy (PELD) has become a mature and mainstream minimal invasive surgical technique in the treatment of lumbar disc herniation (LDH). During the operation, transforaminal puncture is considered as a critical and complicated step which is usually carried out under the guidance of X-ray. However, radiation exposure brings a potential threat to the health of the patients and the surgeons. Besides, nerve roots and vessels may be injured since they are invisible on X-ray. So we still need a real-time accurate image guiding system, especially in difficult cases with anatomic variation. Here we report a case to describe a new method, volume navigation with fusion of real-time ultrasound and CT images, to guide PELD in a patient with right L4-L5 LDH who had anatomic variation of lumbar sacralization. Ultrasound volume navigation guided puncture and cannulation process lasted only 10 minutes and the operation decompression time lasted 60 minutes. The total emission radiation dose was 9mGy. The straight leg elevation increased from 50 to 80 degrees after PELD. The Visual Analog Scale (VAS) of low back pain reduced from 5 to 1 and leg pain reduced from 7 to 1 immediately after PELD. This is the first case of ultrasound volume navigation in guidance of the postural lateral transforaminal puncture and cannulation process of PELD.

Key words: Ultrasound; Volume navigation; CT; Transforaminal percutaneous endoscopic lumbar discectomy; Anatomic variation

Yingying Li, MM, Peng Huang, MD, Shoupeng Li, MM, Mingbo Zhang, MD. Real-time Ultrasound Volume Navigation Guided Transforaminal Percutaneous Endoscopic Lumbar Discectomy in Anatomic Variation: A Case Report. Advanced Ultrasound in Diagnosis and Therapy, 2019, 3(4): 193-196.

References

[1]	Cong L, Zhu Y, Tu G. A meta-analysis of endo-scopic discectomy versus open discectomy for symptomatic lumbar disk herniation. Eur Spine J 2016; 25:134-43.
[2]	Rasouli MR, Rahimi-Movaghar V, Shokraneh F, Moradi-Lakeh M, Chou R. Minimally invasive discectomy versus microdiscectomy/open discectomy for symptomatic lumbar disc herniation. Cochrane Database Syst Rev 2014;9:CD010328.
[3]	Nellensteijn J, Ostelo R, Bartels R, Peul W, van Royen B, van Tulder M . Transforaminal endoscopic surgery for lumbar stenosis: a systematic review. Eur Spine J 2010; 19:879-86.
[4]	Birkenmaier C, Komp M, Leu HF, Wegener B, Ruetten S. The current state of endoscopic disc surgery: review of controlled studies comparing full-endoscopic procedures for disc herniations to standard procedures. Pain Physician 2013; 16:335-44.
[5]	Brenner DJ, Doll R, Goodhead DT, Hall EJ, Land CE, Little JB, et al. Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. Proc Natl Acad Sci U S A 2003; 100:13761-6.
[6]	Galiano K, Obwegeser AA, Bodner G, Freund M, Maurer H, Kamelger FS, et al. Real-time sonographic imaging for periradicular injections in the lumbar spine: a sonographic anatomic study of a new technique. J Ultrasound Med 2005; 24:33-8.
[7]	Kim D, Choi D, Kim C, Kim J, Choi Y. Transverse process and needles of medial branch block to facet joint as landmarks for ultrasound-guided selective nerve root block. Clin Orthop Surg 2013; 5:44-8.
[8]	Chumnanvej S, Wetchagama N, Kounsongtham V. Accuracy of needle-tip localization by ultrasound guidance lumbar selective nerve root block: a prospective clinical study of 78 lumbar nerve roots block. J Med Assoc Thai 2011; 94:1451-6.
[9]	Wing-Fai Loke, Tae-Young Choi, Maleki T, Papiez L, Ziaie B, Byunghoo Jung. Magnetic tracking system for radiation therapy. IEEE Trans Biomed Circuits Syst 2010; 4:223-31.
[10]	Jung EM, Friedrich C, Hoffstetter P, Dendl LM, Klebl F, Agha A, et al. Volume navigation with contrast enhanced ultrasound and image fusion for percutaneous interventions: first results. PloS One 2012; 7:e33956.
[11]	Zacchino M, Almolla J, Canepari E, Merico V, Calliada F. Use of ultrasound-magnetic resonance image fusion to guide sacroiliac joint injections: a preliminary assessment. J Ultrasound 2013; 16:111-8.
[12]	Sartoris R, Orlandi D, Corazza A, Sconfienza LM, Arcidiacono A, Bernardi SP, et al. In vivo feasibility of real-time MR-US fusion imaging lumbar facet joint injections. J Ultrasound 2017; 20:23-31.
[13]	Wobser H, Wiest R, Salzberger B, Wohlgemuth WA, Stroszczynski C, Jung EM. Evaluation of treatment response after chemoembolisation (TACE) in hepatocellular carcinoma using real time image fusion of contrast-enhanced ultrasound (CEUS) and computed tomography (CT)--preliminary results. Clin Hemorheol Microcirc 2014; 57:191-201.
[14]	Chang JM, Han W, Moon HG, Yi A, Cho N, Koo HR, et al. Evaluation of tumor extent in breast cancer patients using real-time MR navigated ultrasound: preliminary study. Eur J Radiol 2012; 81:3208-15.
[15]	Kunishi Y, Numata K, Morimoto M, Okada M, Tanaka K. Efficacy of fusion imaging combining sonography and hepatobiliary phase MRI with Gd-EOB-DTPA to detect small hepatocellular carcinoma. AJR Am J Roentgenol 2012; 198:106-14.
[16]	Xin G, Shi-Sheng H, Hai-Long Z. Morphometric analysis of the YESS and TESSYS techniques of percutaneous transforaminal endoscopic lumbar discectomy. Clin Anat 2013; 26:728-34.