title: Three-dimensional intraoperative imaging with O-arm to establish a working trajectory in percutaneous endoscopic lumbar discectomy.
abstract: BACKGROUND
  Successful percutaneous endoscopic lumbar discectomy (PELD) requires an appropriate working trajectory. Due to the complexity of spinal anatomy, this is difficult to verify with conventional 2-dimensional fluoroscopy.
  
  
  OBJECTIVE
  Here we assessed the feasibility and utility of the O-arm for establishing the working trajectory for PELD.
  
  
  METHODS
  We retrospectively reviewed the records of 89 patients with lumbar disc herniation who underwent PELD using the O-arm. The working trajectory was evaluated with standard fluoroscopic images or 3-dimensional, volumetric computed tomography scan. Based on the detail provided by the multiplanar view, we confirmed the ideal working trajectory and adjusted the surgical approach accordingly.
  
  
  RESULTS
  At the 12-month follow-up, based on MacNab's criteria, 85.9% of patients showed an excellent or good outcome. There were no major complications.
  
  
  CONCLUSIONS
  The O-arm provides detailed multiplanar intraoperative high-quality imaging for PELD, and enables the surgeon to ascertain the surgical anatomy, determine the optimal working trajectory, and improve the accuracy of surgery.
authors: Xuanwu Hospital, Capital Medical University, Beijing, China.
authors: Shu
authors: S
authors: Wei
authors: Xuanwu Hospital, Capital Medical University, Beijing, China.
authors: Wei
authors: W
authors: Tao
authors: Xuanwu Hospital, Capital Medical University, Beijing, China.
authors: Hongwei
authors: H
authors: Zhu
authors: Xuanwu Hospital, Capital Medical University, Beijing, China.
authors: Yongjie
authors: Y
authors: Li
keywords: O-arm; disc herniation; intraoperative imaging; low back pain; percutaneous endoscopic lumbar discectomy