Radiation Exposure Reduction in Ultrasound-Guided Transforaminal Percutaneous Endoscopic Lumbar Discectomy for Lumbar Disc Herniation: A Randomized Controlled Trial.

BACKGROUND: Transforaminal percutaneous endoscopic lumbar discectomy (TF-PELD) is a minimally invasive technique with high radiation exposure. The purpose of this study was to compare radiation exposure of ultrasound-guided TF-PELD with fluoroscopy-guided TF-PELD. METHODS: In this prospective randomized controlled clinical trial, 60 patients with lumbar disc herniation were enrolled and randomly assigned to 2 groups (30 cases in each group): the ultrasound-guided group or the fluoroscopy-guided group. The radiation exposure, fluoroscopy time, and visual analog scale score were recorded. The number of possible operations per year within the yearly occupational exposure limit (OEL) was calculated. We also recorded the adverse events to evaluate the safety of ultrasound-guided TF-PELD. RESULTS: In 30 patients from the ultrasound-guided group, the lumbar disc structure was clearly visible under ultrasound guidance. The effective dose to surgeons and radiation dose to patients were 1.7 ± 0.4 and 25.2 ± 4.9 µSv in the ultrasound-guided group and 9.0 ± 2.5 and 127.4 ± 27.1 µSv in the fluoroscopy-guided group (P < 0.05), respectively. The fluoroscopy time was 2.6 ± 0.5 seconds in the ultrasound-guided group and 127.3 ± 29.5 seconds in the fluoroscopy-guided group (P < 0.05). A surgeon with shielding devices could treat 5556 cases per year in the fluoroscopy-guided group before exceeding the OEL for whole-body radiation, whereas they could treat 29,412 cases in the ultrasound-guided group. No difference between groups was detected in postoperative visual analog scale score (P > 0.58). No serious adverse event was found in any patient. CONCLUSIONS: Ultrasound-guided TF-PELD could decrease radiation exposure to surgeons and patients, without serious adverse events. It seems to be an acceptable alternative to fluoroscopy-guided TF-PELD.

[Application of restorative laminoplasty combined with spinous process osteotomy and internal fixation for treatment of degenerative scoliosis].

OBJECTIVE: For treatment of mild degenerative scoliosis (DS) complicated with lumbar canal stenosis (LCS), posterior decompression and the spinal canal enlargement with spinous process osteotomy was performed in combination with fusion and pedicle screw instrument fixation. METHODS: Between 1999 and 2003, 18 male and 26 female elderly patients (with mean age of 63 years, ranging from 47 to 72 years) with DS complicated with LCS were treated with the described surgical procedures, including 25 with single segment lesion and 19 with involvement of 2 segments. A posterior medical incision from one vertebra superior to the target fusion area till the vertebral segment below it was made for spinal exposure. Undermining enlargement of the spinal canal was carried out according to the segments of the stenosis; in some cases the intervertebral disc was resected. Osteotomy was subsequently performed at the base of the spinous process, and the bony defect was covered with the spinous processes. Finally Moe fusion and Isola (17 cases) or Diapason (27 cases) instrument fixation were performed. The therapeutic effects were evaluated according to Oswestry scores and postoperative imaging examinations. RESULTS: The average follow-up period was 3 years, ranging from 1 to 4 years. Thirty-three patients were followed up for one year and 93.9% of them had excellent or good outcome; 27 patients were followed up of 2 years and showed a rate for excellent or good results of 88.9%. Both sagittal and transverse diameters of the lumbar spinal canal were increased obviously as found by CT scanning without spinal canal scar. A rate of 92.6% of the ostetomized spinous processes had bony fusions. Successful covering bone healing was achieved in a mean of 4 months after surgery. Compressive vertebral fractures superior to the fixed segments occurred in 2 cases, including 1 with pedicle screw loosening and the other with pedicle screw breakage. Another patient had delayed wound healing. No recurrence of LCS, spondylolisthesis and decompensation, or pseudarthrosis of the spine was observed in these cases. CONCLUSION: The described surgical procedures for DS can decrease the occurrence of spinal canal scar and promote the healing of the covering bone, and can be a satisfactory treatment for mild DS complicated with LCS in the lumbar sagittal curve.

[Value of arthroscopy in the diagnosis of acute traumatic cartilage injuries to the knee joint].

We assessed the clinical value of arthroscopy in the diagnosis of acute traumatic cartilage injuries of the knee joint in 27 patients. Cartilage fracture was detected in the patella in 7, in the femur condyle in 3 and the tibial plateau in 6 cases. Arthroscopy proves to be a valuable modality for diagnosis of acute traumatic cartilage fracture of the knee.