A comparative study of double triangle positioning and traditional positioning in percutaneous transforaminal endoscopic discectomy

English Keywords:Lumbar disc herniation  Percutaneous transforaminal endoscopic discectomy  Puncture positioning  Double triangle positioning

English Abstract:

  【Abstract】 Objectives: To propose a positioning method for percutaneous transforaminal endoscopic discectomy and compare its effectiveness with traditional positioning methods. Methods: 65 patients with lumbar disc herniation who underwent percutaneous transforaminal endoscopic discectomy in the Department of Orthopedics of our hospital between January 2025 to May 2025 were enrolled. The patients were divided into two groups based on puncture positioning methods: the double triangle positioning group(33 cases) using the double triangle positioning method and the traditional group(32 cases) using the traditional puncture positioning method. There were no statistical differences in general information between the two groups, including gender, age, underlying medical history(hypertension, diabetes, coronary heart disease), body mass index(BMI), and surgical level(P>0.05). The surgical conditions between the two groups were collected and compared, including puncture placement channel time, fluoroscopy frequency, puncture frequency, total operative time, intraoperative Kolcaba general comfort questionnaire(GCQ) scores; The postoperative pain in the surgical area was assessed using visual analogue scale(VAS) scores 2h after surgery; The intraoperative adverse events and postoperative complications were statistically analyzed. VAS scores for low back pain, VAS scores for leg pain, and Oswestry disability index(ODI) were assessed and recorded preoperatively and at 1d, 1 month, and 3 months postoperatively. Results: Both groups of patients successfully completed the surgery. The double triangle positioning group was less than the traditional group in the puncture placement channel time(14.73±2.34min vs 20.84±2.80min), fluoroscopy frequency(8.21±1.41 vs 13.50±1.98), number of puncture times(2.18±1.07 vs 5.03±1.60), and total operative time(59.58±2.46min vs 68.09±3.09min)(P<0.001). The intraoperative GCQ score in the double triangle positioning group(86.03±3.42) was improved than that of the traditional group(83.88±3.51)(P<0.05). The pain VAS scores in the surgical area within postoperative 2 hours in the double triangle positioning group(2.59±1.22) was less than that of the traditional group(3.27±1.28). The VAS scores for back pain and leg pain and ODI in both groups of patients showed significant improvement at postoperative day 1, month 1, and month 3 compared to preoperative levels(P<0.001), but there was no statistically significant difference between the two groups at any time point(P>0.05). No significant difference was observed in the incidence of intraoperative adverse events and postoperative complications between the two groups(P>0.05). Conclusions: In percutaneous transforaminal endoscopic discectomy, double triangle positioning method can effectively reduce puncture placement channel time, X-ray fluoroscopy frequency, puncture frequency, total operative time, and postoperative 2h pain VAS score in the surgical area, and significantly improve intraoperative comfort of patients, which does not increase the incidence of intraoperative adverse events and postoperative complications.