Novel targeted puncture technique for percutaneous transforaminal endoscopic lumbar discectomy reduces X-ray exposure

The present study explored a method to reduce X-ray exposure dose and avoid targeted puncture complications in percutaneous transforaminal endoscopic lumbar discectomy (PTELD). A total of 66 patients with lumbar disc herniation were divided into two groups for a controlled study. In the experimental group, 31 patients were subjected to PTELD using a novel targeted puncture technique with application of a lumbar disc herniation target collimator. The remaining 35 patients in the control group were subjected to free-hand targeted puncture PTELD. The number of X-ray fluoroscopies performed intraoperatively, targeted puncture accuracy, visual analogue scale for surgical pain and Oswestry disability index of the two groups were statistically analyzed. The experimental and control groups exhibited a statistically significant difference in the number of X-ray fluoroscopies required during the procedure (P<0.01). The number of successful first targeted punctures was 27 (87.1%) in the experimental group and three (8.6%) in the control group, indicating that the puncture accuracy was higher in the experimental group than in the control group. As for the pain response to outer sleeve insertion (local anesthetic injection through the guide sleeve), the experimental group had 25 mild cases (80.6%), five moderate cases (16.1%) and one severe care (3.2%), whereas the control group had five mild cases (14.3%), 19 moderate cases (54.3%) and 11 severe cases (31.4%). These results demonstrated that the overall pain response of the experimental group was milder than that of control group. Due to a larger puncture deviation, the nerve root was touched by the puncture needle in 12 cases in the control group and resulted in one case of severe postoperative infection. In conclusion, the novel targeted puncture technique guided by a lumbar disc herniation target collimator outlined in the present study is able to markedly reduce X-ray exposure dose in PTELD and limit the surgical risk and pain experienced by patients. Mastering this novel puncture technique may aid those new to performing PTELD.