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Skeletal Radiology
Published in: Skeletal Radiology 12/2016

01-12-2016 | Scientific Article

Cone beam computed tomography and its image guidance technology during percutaneous nucleoplasty procedures at L5/S1 lumbar level

Authors: Anna Maria Ierardi, Filippo Piacentino, Francesca Giorlando, Alberto Magenta Biasina, Alessandro Bacuzzi, Raffaele Novario, Gianpaolo Carrafiello

Published in: Skeletal Radiology | Issue 12/2016

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Abstract

Objective

To demonstrate the feasibility of percutaneous nucleoplasty procedures at L5/S1 level using cone beam CT (CBCT) and its associated image guidance technology for the treatment of lumbar disc herniation (LDH).

Materials and methods

We retrospectively reviewed 25 cases (20 men, 5 women) of LDH at L5/S1 levels. CBCT as guidance imaging was chosen after a first unsuccessful fluoroscopy attempt that was related to complex anatomy (n = 15), rapid pathological changes due to degenerative diseases (n = 7) or both (n = 3). Technical success, defined as correct needle positioning in the target LDH, and safety were evaluated; overall procedure time and radiation dose were registered. A visual analog scale (VAS) was used to evaluate pain and discomfort pre-intervention after 1 week and 1, 3, and 6 months after the procedure.

Results

Technical success was 100 %; using CBCT as guidance imaging the needle was correctly positioned at the first attempt in 20 out of 25 patients.
Neither major nor minor complications were registered during or after the procedure. The average procedure time was 11 min and 56 s (range, 9–15 min), whereas mean procedural radiation dose was 46.25 Gy.cm2 (range 38.10–52.84 Gy.cm2), and mean fluoroscopy time was 5 min 34 s (range 3 min 40 s to 6 min 55 s).
The VAS pain score decreased significantly from 7.6 preoperatively to 3.9 at 1 week, 2.8 at 1 month, 2.1 at 3 months, and 1.6 at 6 months postoperatively.

Conclusions

CBCT-guided percutaneous nucleoplasty is a highly effective technique for LDH with acceptable procedure time and radiation dose.
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Metadata
Title
Cone beam computed tomography and its image guidance technology during percutaneous nucleoplasty procedures at L5/S1 lumbar level
Authors
Anna Maria Ierardi
Filippo Piacentino
Francesca Giorlando
Alberto Magenta Biasina
Alessandro Bacuzzi
Raffaele Novario
Gianpaolo Carrafiello
Publication date
01-12-2016
Publisher
Springer Berlin Heidelberg
Published in
Skeletal Radiology / Issue 12/2016
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-016-2486-4

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