Volume Navigation Using Fusion Of Real-time Ultrasound With Computed Tomographic Images To Guide Posterolateral Transforaminal Puncture In Percutaneous Endoscopic Lumbar Discectomy(PELD)in Vitro And In Vivo

Purpose:We evaluated the accuracy of a volume navigation technique using fusion of real-time ultrasound(US) with computed tomographic(CT) images for guiding percutaneous posterolateral transforaminal puncture in cadaver models and then in patients.Materials and Methods:Volume navigation-guided transforaminal puncture was performed on both sides at the L4/5 level in 15 cadavers. The registration error, time of overall puncture, US-observed distance between needle tip and target (DNT), and puncture error were recorded. The same procedures were tested in 63 patients with lumbar disc herniations(LDH) who had prior percutaneous endoscopic lumbar discectomy (PELD). Transforaminal puncture was carried out under C-arm guidance (n=30), and the time of puncture and frequency of fluoroscopy were recorded. In the second group (n=33), transforaminal puncture was carried out under volume navigation guidance. Both groups were evaluated with the Oswestry Disability Index (ODI) and a visual analogue scale (VAS).Results:In the cadaver experiment, the mean registration error was 2.66 mm; mean DNT 18.98 mm; mean puncture error 2.91 mm; and mean overall time of puncture 22.1 min. In the clinical trial, time of puncture and frequency of fluoroscopy were significantly lower in the volume navigation group compared with the C-arm guidance group (P<0.001). There were no significant differences between the two groups in the preoperative and postoperative ODI and VAS scores (P> 0.05).Conclusion:Compared with conventional C-arm navigation, the volume navigation technique can guide percutaneous posterolateral transforaminal puncture more accurately, reducing puncture time and radiation dose. Therefore, it can be applied for PELD.