Abstract

Introduction: Although percutaneous endoscopic lumbar discectomy (PELD) for lumbar disc herniations shows satisfactory outcomes, there have been cases in which the PELD has failed because of the incomplete removal of disc fragments. The hybrid magnetic resonance/X-ray suite (X-MR) is a recently introduced imaging solution that provides intraoperative images. Preoperatively X-MR images were taken without changing prone position during the procedure to determine a precise skin entry point and evaluate any change in size or location of herniated disc. Before the finishing the procedure, X-MR was checked. The purpose of this study is to present our early experience in X-MR assisted PELD. Methods: A retrospective analysis was performed in 107 patients who underwent X-MR assisted PELD. We obtained preoperative X-MR by placing skin markers on patient's back. Intraoperatively, X-MR was repeated in case of doubtful remnant fragment. When remnants were found, procedure was continued until the fragments were removed completely. Results: The mean follow-up period was 7.2 months. Based on the modified Macnab criteria, 91.2% showed excellent or good outcomes. The mean VAS decreased from 7.82 to 2.17 (p<.05) and the ODI decreased from 59.2 to 9.25 (p<.05). 7 patients demonstrated the progression of disc herniation in preoperative X-MR. One patient needed open surgery after PELD due to persistence of radiculopathy. Only three patients showed recurrent disc herniation during follow up. Conclusions: The X-MR assisted PELD facilitates in locating precise skin entry point and confirm complete removal of disc fragment intraoperatively, thereby increasing the success rate. Longer-term analysis can help in outlining the true benefits of this technique.