Related Experiment Video
Updated: Jul 14, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Fluoroscopic Spinal Catheter Tip Guidance in Lumboperitoneal Shunting: Mechanistic Basis for Preventing Radicular
Yukihiro Goto1, Masayuki Yamagishi, Takuro Inoue
1Department of Neurosurgery, Subarukai Koto Memorial Hospital 2-1 Hiramatsu-cho, Higashiohmi-shi, Shiga, Japan.
Background And Objectives:
Postoperative radicular leg pain occasionally occurs after lumboperitoneal shunting (LPS), yet its mechanism remains poorly understood. Preventing this complication is essential for the wider, safer application of LPS. To analyze whether intraoperative fluoroscopy could eliminate high-risk intradural catheter tip configurations and control radicular pain, based on the observation that patients with postoperative pain often exhibit specific tip configurations.
Methods:
We conducted a single-center retrospective before-and-after cohort study of 114 consecutive LPS procedures (85 without fluoroscopy, 29 with fluoroscopy). The primary end point was new-onset radicular pain within 30 days; persistence at 3 months was a secondary endpoint. Fisher exact test, absolute risk differences, and risk ratios with 95% CIs were calculated.
Results:
Radicular pain occurred in 9 of 85 patients (10.6%) without fluoroscopy and in none (0/29) with fluoroscopy (risk difference -10.6%; 95% CI -18.9% to 6.0%; P = .109). At 3 months, persistence was 5.9%, compared with 0% at 0 months. Fluoroscopy increased the rate of ideal straight-cephalad tip placement and eliminated caudal, kinked, and looping configurations. No fluoroscopy-related complications occurred.
Conclusion:
Intraoperative fluoroscopy may help prevent postoperative radicular pain by optimizing spinal catheter tip trajectory. This simple, low-dose, and reproducible technique provides a mechanistic and practical solution for preventing this clinically significant complication.
