Journal of Shandong University (Health Sciences) ›› 2025, Vol. 63 ›› Issue (3): 14-21.doi: 10.6040/j.issn.1671-7554.0.2024.1205

• Clinical Diagnosis and Treatment in Orthopedics • Previous Articles    

Construction of a transforaminal endoscopic surgical path based on bone landmarks in intraoperative C-arm X-ray radiographs

ZHANG Yixiang1, LIANG Yuanhao2, YANG Wenlong3, LI Guoqiang3, WU Wenqing3, LIU Lei3   

  1. 1. College of Traditional Chinese Medicine, Shandong Second Medical University, Weifang 261053, Shandong, China;
    2. Department of Public Service, Yantai Preschool Teachers College, Yantai 265600, Shandong, China;
    3. Department of Pain Medicine, The First Affiliated Hospital of Shandong First Medical University, Jinan 250014, Shandong, China
  • Published:2025-04-08

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Abstract: Objective To summarise the rules of lateral puncture positioning for the intervertebral foramen endoscopy by analyzing thin-slice CT images of the lumbar spine and to construct a surgical path for intervertebral foramen endoscopy based on the intraoperative C-arm X-ray bone landmarks, so as to apply it to clinical verification of its safety and effcacy. Methods (1) Thirty patients with lumbar disc herniation(LDH)admitted to The First Affiliated Hospital of Shandong First Medical University from January 2022 to May 2024 were selected for lumbar thin-layer CT imageing. The rules of lateral puncture of intervertebral foramen endoscopy were explored through imaging anatomy research, and the method of fixed-point puncture of the cross line of bone landmarks on intraoperative C-arm X-ray imageing was established to construct a safe and effective puncture path of intervertebral foramen endoscopy. (2) Eighty patients with LDH who underwent intervertebral foramen endoscopy surgery in our hospital from May 2023 to May 2024 were selected and divided into the cross-point positioning method group(n=40)and the surface positioning method group(n=40)according to the random number table method. All patients underwent lateral foraminal endoscopic surgery, and the surgery was performed by senior physicians experienced in spinal endoscopic surgery according to the principle of random allocation. The clinical efficacy, intraoperative parameters and postoperative complications of the two groups were observed and analysed. Results The overall efficacy rate of the observation group was higher than that of the control group, and the difference between the two groups was statistically significant(P<0.05). The single puncture success rate was 97.5% in the cross-point positioning method group and 80% in the surface positioning method group, and the difference between the two groups was statistically significant(P<0.05). The time to establish the working channel was(16.32±3.97)min in the cross-point positioning method group and(26.32±5.93)min in the surface positioning method group, and the difference between the two groups was statistically significant(P<0.05). The mean number of fluoroscopy times was 8.93±2.12 in the cross-point positioning method group and 17.53±2.73 in the surface positioning method group, with a statistically significant difference between the two groups(P<0.001). The intraoperative fluoroscopic radiation dose in the cross-point positioning method group was(10.27±5.72)mGy, while that in the cross-point positioning method group was(17.16±4.27)mGy, with a significant difference between the two groups(P<0.01). The postoperative VAS score and ODI scores in the cross-point positioning method group were significantly lower than those in the surface positioning method group(P<0.05). There was no serious complications occurred in either group. Conclusion The cross-point positioning method has significant advantages over the previous puncture positioning method, and provides a safe, effective, accurate, easy-to-mark, simple and easy-to-learn puncture positioning method for transforaminal endoscopic lumbar discectomy.

Key words: Surgical pathway construction, Transforaminal endoscopic lumbar discectomy, Imaging anatomy, Bony landmarks, C-arm X-ray

CLC Number: 

  • R615
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