Zhaokui Yan1, Guy Romeo Kenmegne2, Lixue Wu3, Xiaobing Pu1, Changchao Dong1, Gang Tan1, Hongyun Wo,1, Chengwei Kang1

1Department of Orthopaedics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
2Department of Orthopaedics, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
3Department of Pathology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu Sichuan, China
4Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China

Keywords: Lumbar disc herniation, magnetic resonance imaging, operation time, picture archiving and communication systems, transforaminal lumbar epidural injection, treatment cost, X-ray fluoroscopy


Objectives: The study aimed to compare the treatment cost, operation time, clinical effect, and complications between punctures done under magnetic resonance imaging (MRI) planning based on picture archiving and communication systems (PACS) and punctures done under immediate X-ray fluoroscopy guidance in the treatment of lumbar disc herniation by transforaminal lumbar epidural injection.

Patients and methods: In this prospective study conducted between October 2016 and June 2021, 128 patients were randomly divided into Groups A and B by the random number table method. In Group A (n=66; 36 males, 30 females; mean age: 64.5±2.4 years, range, 50 to 72 years), puncture was performed by planning with PACS-based MRI; in Group B (n=62; 34 males, 28 females; mean age: 65.3±2.6 years; range, 48 to 73 years), puncture was performed under immediate X-ray guidance. The cost of treatment, duration of procedure, clinical outcome, and complications were compared between the two groups.

Results: The difference in treatment cost in Groups A and B was statistically significant (p<0.001), with 755.67±29.45 yuan and 1.158.08±43.92 yuan, respectively. The mean treatment time was statistically significant (p<0.001) between the groups, with 21.16±1.91 min in Group A and 37.26±2 min in Group B. However, there was no significant difference between Group A and Group B in terms of improvement in pain scores and Oswestry disability index (both p>0.05). There was also no significant difference between Group A and Group B in terms of complication rates (both p>0.05).

Conclusion: Compared to immediate X-ray guided puncture, the puncture method using PACS for MRI planning shortened the transforaminal lumbar epidural injection procedure time and reduced the treatment costs without exposing the physician or patient to additional radiation, while there was no significant difference in the short-term clinical outcome or complication rate.

Citation: Yan Z, Kenmegne GR, Wu L, Pu X, Dong C, Tan G, et al. A comparison between transforaminal lumbar epidural injection performed under picture archiving and communication systemsbased magnetic resonance imaging planning and injection under immediate X-ray guidance. Jt Dis Relat Surg 2024;35(1):45- 53. doi: 10.52312/jdrs.2023.1260.

Ethics Committee Approval

This study was reviewed by the Ethics Committee of West China School of Public Health/ West China Fourth Hospital of Sichuan University (no: HXSYEC-2022033). The study was conducted in accordance with the principles of the Declaration of Helsinki.

Author Contributions

Responsible for statistical analysis and the revision of articles: Z.Y.; Responsible for research design and article writing: C.K.; Lecture of the manuscript and literature review: L.W., G.R.K.; Orthopedic care of the patient, collect and sort out relevant original data: C.D., G.T., H.W., X.P.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.