Feasibility of Virtual Reality Combined with Isocentric Navigation in Transforaminal Percutaneous Endoscopic Discectomy: A Cadaver Study

Objectives Transforaminal percutaneous endoscopic discectomy (TPED) is one of the most commonly used minimally invasive spine surgeries around the world. However, conventional surgical planning and intraoperative procedures for TPED have relied on surgeons' experience, which limits its standardization and popularization. Virtual reality (VR) is a novel technology for pre-surgical planning in various fields of medicine, while isocentric navigation can guide intraoperative procedures for TPED. The present study aimed to explore the feasibility of applying VR combined with isocentric navigation in TPED on cadavers. Methods The surgical levels were L-3/L-4 and L-4/L-5 as well as L-5/S-1 of both sides of each cadaver specimen. First, the surgeon manually conducted the above procedures on the left side of every specimen without preoperative simulation and isocentric navigation (Group A). Then the same surgeon conducted the VR simulation for surgical planning of the right side (Group B). After VR simulation, the same surgeon made the percutaneous punctures and placed the working channel on the right side of the specimen at all levels. Results At the L-3/L-4 level, the puncture-channel time was 11.36 +/- 2.13 min in Group A and 11.29 +/- 2.23 min in Group B (t = 0.097, P = 0.938). The exposure time was 17.21 +/- 2.91 s in Group A and 14.64 +/- 1.60 s in Group B (t = 2.534, P = 0.025). At the L-4/L-5 level, the puncture-channel time was 13.86 +/- 3.90 min in Group A and 11.93 +/- 2.95 min in Group B (t = 2.291, P = 0.039). Exposure time was 20.64 +/- 3.84 s in Group A and 16.43 +/- 2.47 s in Group B (t = 6.118, P < 0.01). There were 7 patients undergoing foraminotomy in Group A and 3 patients undergoing foraminotomy in Group B (t = 2.280, P = 0.236). At the L-5/S-1 level, the puncture-channel time was 18.21 +/- 1.85 min in Group A and 15.71 +/- 3.20 min in Group B (t = 2.476, P = 0.028). Exposure time was 26.07 +/- 3.17 s in Group A and 22.50 +/- 2.68 s in Group B (t = 2.980, P = 0.011). There were 14 patients receiving foraminotomy in Group A and 13 patients receiving foraminotomy in Group B (t = 1.000, P = 1.000). Conclusions Virtual reality combined with isocentric navigation is feasible in TPED. It enables precise surgical planning and improves intraoperative procedures, and has the potential for application in clinical practice.