A New Targeted Puncture Technique for Percutaneous Transforaminal Endoscopic Lumbar Discec-tomy in Treatment of Lumbar Disc Herniation

Abstract：Objective To explore the methods to reduce X-ray exposure and avoid targeted puncture complications in per-cutaneous transforaminal endoscopic lumbar discectomy(PTELD). Methods 46 patients with lumbar disc herniation were subjected to PTELD using a new targeted puncture technique with application of a lumbar disc herniation target guiding appara-tus. The times of X-ray fluoroscopy,the targeted puncture accuracy,the degree of pain response during surgery,and visual ana-logue scale(VAS),Oswestry disability index(ODI),Macnab postoperatively were reviewed. Results 38 cases in success of firstpuncture( 8 2 . 6 % ),6 cases in success of puncture two times( 1 3 . 1 % ),2 cases in success of puncture three times (4. 3% ). As for pain response under local anesthesia,outcomes were mild 37 cases(80. 4% ),moderate 8 cases(17. 4% ) and severe 1 care(2. 2% ). The average number of times of X-ray fluoroscopy was 5. 6 times. No nerve injury,large blood ves-sel injury,dural laceratione and infection was observed. Average follow-up 10. 6 months,VAS and ODI scores preoperatively and postoperatively had statistically significant difference(P < 0. 05). According to Macnab criteria,the surgical outcomes were excellent in 38 cases,good in 6 cases,fair in 2 cases,poor in 0 case,with the excellent-to-good rate of 95. 7% . Conclu-sion The new targeted puncture technique can significantly reduce X-ray exposure in PTELD,as well as the surgical risk and patient′s pain response. this new puncture technique will greatly help new learners of PTELD.