Randomized Controlled Trial
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 6, 2023; 11(16): 3802-3812
Published online Jun 6, 2023. doi: 10.12998/wjcc.v11.i16.3802
Coaxial radiography guided puncture technique for percutaneous transforaminal endoscopic lumbar discectomy: A randomized control trial
Li-Ping Chen, Bin-Song Wen, Heng Xu, Zheng Lu, Lai-Jun Yan, Han Deng, Hong-Bo Fu, Hong-Jie Yuan, Pei-Pei Hu
Li-Ping Chen, Heng Xu, Department of Pain Management, The Affiliated Hospital of Xuzhou Medical College, Xuzhou 221000, Jiangsu Province, China
Bin-Song Wen, Lai-Jun Yan, Han Deng, Hong-Bo Fu, Hong-Jie Yuan, Pei-Pei Hu, Department of Pain Management, Nantong Hospital of Traditional Chinese Medicine, Nantong 226000, Jiangsu Province, China
Zheng Lu, Department of Neurosurgery, Haian People's Hospital, Nantong 226001, Jiangsu Province, China
Author contributions: Yuan HJ, Chen LP, and Xu H designed the research study; Yuan HJ and Chen LP performed the procedure; Hu PP, Fu HB, and Xu H recorded the outcomes; Wen BS, Deng H, and Lu Z did the statistical work, Wen BS, Yan LJ, and Yuan HJ wrote the manuscript; all authors have read and approved the final manuscript.
Institutional review board statement: This study complied with The Declaration of Helsinki, and the trial was approved by the Institutional Ethics Committee of Clinical Research of Nantong Hospital of Traditional Chinese Medicine (Approval No. 20221230-5).
Clinical trial registration statement: The clinical trial was registered on the Chinese Clinical Trial Registry website (Registration number ChiCTR2200058894).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors declare no potential conflicting interests related to this paper.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong-Jie Yuan, MD, Doctor, Department of Pain Management, Nantong Hospital of Traditional Chinese Medicine, No. 41 Jianshe Road, Chongchuan District, Nantong 226000, Jiangsu Province, China. yuanhongjie81@foxmail.com
Received: December 11, 2022
First decision: January 30, 2023
Revised: February 19, 2023
Accepted: April 19, 2023
Article in press: April 19, 2023
Published online: June 6, 2023

The coaxial radiography-guided puncture technique (CR-PT) is a novel technique for endoscopic lumbar discectomy. As the X-ray beam and the puncturing needle are maintained in a parallel and coaxial direction, the X-ray beam can be used to guide the trajectory angle, facilitating the choice of the puncture site and providing real-time guidance. This puncture technique offers numerous advantages over the conventional anterior-posterior and lateral radiography-guided puncture technique (AP-PT), especially in cases of herniated lumbar discs with a hypertrophied transverse process or articular process, high iliac crest, and narrowed intervertebral foramen.


To confirm whether CR-PT is a superior approach to percutaneous transforaminal endoscopic lumbar discectomy compared to AP-PT.


In this parallel, controlled, randomized clinical trial, herniated lumbar disc patients appointed to receive percutaneous endoscopic lumbar discectomy treatment were recruited from the Pain Management Department of the Affiliated Hospital of Xuzhou Medical University and Nantong Hospital of Traditional Chinese Medicine. Sixty-five participants were enrolled and divided into either a CR-PT group or an AP-PT group. The CR-PT group underwent CR-PT, and the AP-PT group underwent AP-PT. The number of fluoroscopies during puncturing, puncture duration (min), surgery duration (min), VAS score during puncturing, and puncture success rate were recorded.


Sixty-five participants were included, with 31 participants in the CR-PT group and 34 in the AP-PT group. One participant in the AP-PT group dropped out due to unsuccessful puncturing. The number of fluoroscopies [median (P25, P75)] was 12 (11, 14) in the CR-PT group vs 16 (12, 23) in the AP-PT group, while the puncture duration (mean ± SD) was 20.42 ± 5.78 vs 25.06 ± 5.46, respectively. The VAS score was 3 (2, 4) in the CR-PT group vs 3 (3, 4) in the AP-PT group. Further subgroup analysis was performed, considering only the participants with L5/S1 segment herniation: 9 patients underwent CR-PT, and 9 underwent AP-PT. The number of fluoroscopies was 11.56 ± 0.88 vs 25.22 ± 5.33; the puncture duration was 13.89 ± 1.45 vs 28.89 ± 3.76; the surgery duration was 105 (99.5, 120) vs 149 (125, 157.5); and the VAS score was 2.11 ± 0.93 vs 3.89 ± 0.6, respectively. All the above outcomes demonstrated statistical significance (P < 0.05), favoring the CR-PT treatment.


CR-PT is a novel and effective technique. As opposed to conventional AP-PT, this technique significantly improves puncture accuracy, shortens puncture time and operation time, and reduces pain intensity during puncturing.

Keywords: Herniated lumbar disc, Coaxial, Puncture, Anterior-posterior, L5/S1

Core Tip: Puncturing is the first step for percutaneous endoscopic lumbar discectomy. Compared with the anterior-posterior and lateral radiography-guided puncture technique (AP-PT), the coaxial radiography-guided puncture technique (CR-PT) has the advantage of guiding the trajectory angle, facilitating the choice of the puncture site, and also providing real-time guidance for puncturing. This study aimed to compare the two techniques. In this randomized controlled trial, the CR-PT technique demonstrated significantly better puncture accuracy, and shorter puncturing and operation duration. We argue that the CR-PT technique is an advisable option in percutaneous endoscopic lumbar discectomy, especially for unusual cases.