Trajectory Planning and Guided Punctures with Isocentric Navigation in Posterolateral Endoscopic Lumbar Discectomy.

Abstract

Posterolateral endoscopic trasforaminal discectomy (PELD) requires an ideal percutaneous puncture to place the working channel for endoscopic discectomy. The conventional blinded puncture relies on the surgeon's experience and repeated fluoroscopy, which may increase radiation exposure. This study aimed to introduce isocentric navigation to plan trajectory and guide punctures in PELD. Technical note and clinical outcomes of patients undergoing PELD with isocentric navigation were recorded in this report. Four patients (3 female, 1 male) were included in this study. Age ranged from 21 to 67 years, and the body mass index ranged from 18.71 to 23.15 kg/m². All of the included patients received just one puncture, and the radiation exposure time ranged from 15 to 40 seconds. The operation time ranged from 58 to 75 minutes, and no significant complications were observed. All patients reported significant pain relief and improved surgical outcomes, as assessed by the Oswestry Disability Index and Macnab criteria. Isocentric navigation is feasible in planning the trajectory and guiding the punctures in PELD and could be considered as a potential practical tool to facilitate surgery.