ABSTRACT
BACKGROUND:A large number of literatures have shown that surgeons expose to a higher radiation dose during puncture and bone cement injection in percutaneous vertebral augmentation. OBJECTIVE:To review the research progress in radiation doses and safeguard procedures in percutaneous vertebral augmentation. METHODS: By using percutaneous vertebral augmentation, radiation doses, radiation protective as key words, we retrieved articles related to radiological protection during percutaneous vertebral augmentation published from January 1995 to December 2014 in Wangfang database and PubMed database. RESULTS AND CONCLUSION:One basic principle of radiation protection is that the radiation dose decreases rapidly with distance from the radioactive sources. Surgeons should maximize the distance from the radioactive sources as far as possible in case there is no effect on the operation. To optimize the setting and position of C-arm machine, wear protective devices and put lead shields as wel as computer navigation and radiation training in surgeons al can help to reduce the radiation doses during percutaneous vertebral augmentation. Remote bone cement injection device is easy to control but not increases the radiation doses. In addition, the influence of surgery bed on radiation dose remains to be further studied. We believe that with the in-depth research on radiological protection, vertebral augmentation technique wil be safer in clinical application.
ABSTRACT
BACKGROUND: It is often difficult to determine the cause of low back pain (LBP) in the patients with lumbar disc herniation. The herniated disc has long been thought to be an important cause of the patient's complaint about LBP and sciatica. Whether the adjacent degenerative disc results in LBP needs further confirmations. OBJECTIVE: This study sought to determine whether the degenerative disc adjacent to the herniated disc in patients with LBP and radicular pain can result in discogenic LBP, as assessed by provocative discography, and to report the outcomes of the residual LBP when adjacent symptomatic disc were treated with methylene blue after microendoscopic discectomy. METHODS: Twenty lumbar disc herniation patients complaint about LBP and radicular pain underwent provocative discography. There was one degenerative herniated disc with one or more adjacent degenerative discs in their MRI. Provocative discography was performed on all degenerative discs and at least one normal disc for control. The severity of LBP and leg pain of all patients was assessed using visual analog scale before discography. All patients underwent microendoscopic discectomy at herniated level, and intradiscal injection of methylene blue was given at painful adjacent level in five patients after microendoscopic discectomy. RESULTS AND CONCLUSION: Discographies were performed on 64 discs of 20 patients, from L2-3 to L5-S1. There were 11 discs satisfying the positive response criteria, including 6 in degenerative segment adjacent to the herniated disc and 5 in the herniated disc that induced corresponding radiculopathy. The leg pains were evidently improved in all patients, while LBP was partially improved after microendoscopic discectomy. Six patients with symptomatic adjacent degenerative disc still had evident LBP, influencing their daily living. Five of them received intradiscal injection of methylene blue treatment and the LBP was relived. One patient refusing to the treatment still complained the LBP. Results evidenced that accompanying LBP for many LDH patients may come from the degenerative levels adjacent to the herniated disc.