Published online May 26, 2019. doi: 10.12998/wjcc.v7.i10.1161
Peer-review started: January 14, 2019
First decision: January 30, 2019
Revised: March 1, 2019
Accepted: March 16, 2019
Article in press: March 16, 2019
Published online: May 26, 2019
Percutaneous endoscopic lumbar discectomy (PELD) has become a mature and mainstream minimally invasive surgical technique for treating lumbar disc herniation (LDH). Repeated fluoroscopy, with more than 30 shots on average, is inevitable to ensure its accuracy and safety. However, exposure to X-rays may pose a threat to human health. We herein report a case of ultrasound (US)-assisted PELD in two levels of LDH to explore a new possibility that can reduce the radiation dose during puncture and cannulation in PELD.
A 38-year-old man with low back pain and left leg pain for more than 7 years came to our clinic, his symptoms had aggravated for 1 month, and he was diagnosed with L3-4 and L4-5 disc herniations. He received US-guided PELD with good results: His straight leg elevation increased from 40 to 90 degrees after PELD, and his visual analog scale (VAS) and Oswestry Disability Index scores both significantly decreased immediately and 6 mo after PELD. With the guidance of US, he received only two shots of fluoroscopy (fluoroscopic time: 4.4 s; radiation dose: 3.98 mGy). To our knowledge, this is the first case of US-guided puncture and cannulation of PELD for LDH at two levels.
US could be used to guide PELD and has the potential to largely reduce radiation than traditional X-ray guidance.
Core tip: Percutaneous endoscopic lumbar discectomy, a mature and mainstream minimally invasive surgical technique for treating lumbar disc herniation (LDH), needs more than 30 shots of fluoroscopy each level on average, causing a threat to human health. With the help of ultrasound (US) guidance, we report a patient with two levels of LDH who received only two shots to achieve satisfactory results. US guidance has great potential to become an alternative method to reduce radiation largely.