Evaluation of an experimentally designed stereotactic guidance system for determining needle entry point during uniplanar fluoroscopy-guided intervention

Abstract

Background: In discography performed during percutaneous endoscopic lumbar discectomy (PELD) via the posterolateralapproach, it is difficult to create a fluoroscopic tunnel view because a long needle is required for discographyand the guide-wire used for consecutive PELD interrupts rotation of fluoroscope. A stereotactic system wasdesigned to facilitate the determination of the needle entry point, and the feasibility of this system was evaluatedduring interventional spine procedures. Methods: A newly designed stereotactic guidance system underwent a field test application for PELD. Sixty patientswho underwent single-level PELD at L4-L5 were randomly divided into conventional or stereotactic groups.PELD was performed via the posterolateral approach using the entry point on the skin determined bypremeasured distance from the midline and angles according to preoperative magnetic resonance imaging (MRI)findings. Needle entry accuracy provided by the two groups was determined by comparing the distance andangle measured by postoperative computed tomography with those measured by preoperative MRI. The durationand radiation exposure for determining the entry point were measured in the groups. Results: The new stereotactic guidance system and the conventional method provided similarly accurate entry pointsfor discography and consecutive PELD. However, the new stereotactic guidance system lowered the durationand radiation exposure for determining the entry point. Conclusions: The new stereotactic guidance system under fluoroscopy provided a reliable needle entry point fordiscography and consecutive PELD. Furthermore, it reduced the duration and radiation exposure associatedwith determining needle entry. © The Korean Pain Society, 2012.