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 mu Sv in the ultrasound-guided group and 9.0 +/- 2.5 and 127.4 +/- 27.1 mu Sv 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.