Yi Mao, Peng Huang, Yuhong Tao, Chao Zhang, Mingbo Zhang
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The biplane US group was divided into training and proficiency stages using a learning curve fitted by cumulative sum analysis. All punctures were performed by a junior spine surgeon and a junior sonographer. The primary outcomes were the first success rate, number of punctures and radiographs, puncture time, and confidence score.</p><p><strong>Results: </strong>Sixty-eight patients (age 51.4±15.4 yr, 36 males) were divided into the biplane US and fluoroscopy groups. According to the 12th turning point of a learning curve, the biplane US group was divided into training and proficiency periods. The first-attempt success rate was achieved in 61% using biplane US at the proficiency period, compared with 32% using fluoroscopy [ P =0.033, RR: 1.634]. The number of radiographies [1 (IQR 1-2) vs . 2 (IQR 2-3), P =0.001] was significantly smaller, and puncture time [120 s (IQR 57-210) vs. 197 s (IQR 159-341), P =0.001] was significantly faster using biplane US at the proficiency period.</p><p><strong>Conclusion: </strong>Biplane US provides an accurate, safe, and convenient approach for PLIFI. With further clinical practice, biplane US would be conducive to rapid skill acquisition for novices and has the potential to achieve a completely radiation-free puncture process.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"686-693"},"PeriodicalIF":2.6000,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Biplane Ultrasound Versus Fluoroscopy for Guidance of Percutaneous Lumbar Intervertebral Foramen Insertion : A Randomized Controlled Clinical Trial.\",\"authors\":\"Yi Mao, Peng Huang, Yuhong Tao, Chao Zhang, Mingbo Zhang\",\"doi\":\"10.1097/BRS.0000000000005295\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study design: </strong>A randomized controlled study.</p><p><strong>Objective: </strong>The aim of this study was to develop a clinical process of biplane ultrasound (US) guided percutaneous lumbar intervertebral foramen insertion (PLIFI) and to verify that biplane US can improve accuracy and reduce number of fluoroscopies.</p><p><strong>Summary of background data: </strong>PLIFI is crucial for drug injection and establishment of transforaminal surgical channel. 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引用次数: 0
摘要
研究设计：随机对照研究。目的：本研究的目的是建立双翼超声（US）引导下经皮腰椎椎间孔插入（PLIFI）的临床流程，并验证双翼超声（US）可以提高准确性并减少透视次数。背景资料总结：PLIFI对于药物注射和椎间孔外科通道的建立至关重要。传统的透视指导涉及辐射，需要实际经验。方法：将计划行硬膜外类固醇注射或经皮内镜下腰椎间盘切除术的腰椎间盘突出症患者随机分为双翼超声组和透视组。使用累积和分析拟合的学习曲线将美国双翼机组分为训练和熟练阶段。所有穿刺均由一名初级脊柱外科医生和一名初级超声医师进行。主要观察指标为首次成功率、穿刺次数、x线片次数、穿刺时间和信心评分。结果：68例患者（年龄51.4±15.4岁，男性36例）分为双翼超声组和透视组。根据学习曲线的第12个拐点，将双翼飞机美国组分为训练期和熟练期。熟练期使用双翼超声检查的首次成功率为61%，而使用透视检查的首次成功率为32% [P=0.033, RR: 1.634]。在熟练期，使用双翼飞机US的x线片数量[1 (IQR 1 ~ 2) vs. 2 (IQR 2 ~ 3)， P=0.001]明显更少，穿刺时间[120 s (IQR 57 ~ 210) vs. 197 s (IQR 159 ~ 341)， P=0.001]明显更快。结论：双翼US为PLIFI手术提供了准确、安全、方便的入路。随着进一步的临床实践，双翼US将有助于新手快速掌握技能，并有可能实现完全无辐射的穿刺过程。
Biplane Ultrasound Versus Fluoroscopy for Guidance of Percutaneous Lumbar Intervertebral Foramen Insertion : A Randomized Controlled Clinical Trial.
Study design: A randomized controlled study.
Objective: The aim of this study was to develop a clinical process of biplane ultrasound (US) guided percutaneous lumbar intervertebral foramen insertion (PLIFI) and to verify that biplane US can improve accuracy and reduce number of fluoroscopies.
Summary of background data: PLIFI is crucial for drug injection and establishment of transforaminal surgical channel. The traditional fluoroscopy guidance involves radiation and requires practical experience.
Methods: Patients with lumbar disc herniation scheduled for an epidural steroid injection or percutaneous endoscopic lumbar discectomy were randomized to the biplane US and fluoroscopy groups. The biplane US group was divided into training and proficiency stages using a learning curve fitted by cumulative sum analysis. All punctures were performed by a junior spine surgeon and a junior sonographer. The primary outcomes were the first success rate, number of punctures and radiographs, puncture time, and confidence score.
Results: Sixty-eight patients (age 51.4±15.4 yr, 36 males) were divided into the biplane US and fluoroscopy groups. According to the 12th turning point of a learning curve, the biplane US group was divided into training and proficiency periods. The first-attempt success rate was achieved in 61% using biplane US at the proficiency period, compared with 32% using fluoroscopy [ P =0.033, RR: 1.634]. The number of radiographies [1 (IQR 1-2) vs . 2 (IQR 2-3), P =0.001] was significantly smaller, and puncture time [120 s (IQR 57-210) vs. 197 s (IQR 159-341), P =0.001] was significantly faster using biplane US at the proficiency period.
Conclusion: Biplane US provides an accurate, safe, and convenient approach for PLIFI. With further clinical practice, biplane US would be conducive to rapid skill acquisition for novices and has the potential to achieve a completely radiation-free puncture process.
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Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.
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