title: Cone beam computed tomography and its image guidance technology during percutaneous nucleoplasty procedures at L5/S1 lumbar level.
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).
  
  
  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.
authors.affiliation: Unit of Interventional Radiology, Department of Radiology, University of Insubria, Varese, 21100, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Ierardi
authors.affiliation: Unit of Interventional Radiology, Department of Radiology, University of Insubria, Varese, 21100, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Piacentino
authors.affiliation: Unit of Interventional Radiology, Department of Radiology, University of Insubria, Varese, 21100, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Giorlando
authors.affiliation: Department of Diagnostic and Interventional Radiology, University of Milan, San Paolo Hospital, 20142, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Magenta Biasina
authors.affiliation: Anaesthesia and Palliative Care, University of Insubria, Varese, 21100, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Bacuzzi
authors.affiliation: Medical Physics Department, University of Insubria, 21100, Varese, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Novario
authors.affiliation: Department of Diagnostic and Interventional Radiology, University of Milan, San Paolo Hospital, 20142, Milan, Italy. gcarraf@gmail.com.
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Carrafiello
mesh_terms: D054893:Cone-Beam Computed Tomography; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging* / Q000601:surgery*; D008159:Lumbar Vertebrae; D008297:Male; D009339:Needles; D019637:Orthopedic Procedures; D010147:Pain Measurement; D056888:Patient Positioning; D012189:Retrospective Studies; D012984:Software; D025321:Surgery, Computer-Assisted; D016896:Treatment Outcome
keywords: CBCT; Cone beam computed tomography; L5/S1 lumbar level; Percutaneous nucleoplasty