An animal model study of simplified optical navigation system-assisted percutaneous lumbar transforaminal puncture

Optical navigation systems can provide real-time visualization of the positional relationship between surgical instruments and patient anatomy, making them suitable for assisting in puncture localization during percutaneous transforaminal endoscopic discectomy (PTED). However, current research on optically-navigated puncture localization during PTED is still limited, with high equipment costs and complex operational techniques being the main barriers to widespread adoption. 3D Slicer is a powerful open-source medical image analysis and visualization platform that can be integrated with external optical trackers to construct a low-cost optical navigation system for assisted puncture procedures. This study aims to develop a simplified optical navigation system based on an optical tracker and 3D Slicer software, and to evaluate its effectiveness in assisting percutaneous lumbar foraminal puncture through animal model experiments.

A simplified optical navigation system based on an optical tracker and 3D Slicer software was developed. Eight fresh goat lumbar spine segments were randomly divided into the navigation group and control group. The two groups underwent the lumbar foraminal puncture procedure with different guidance modalities: the navigation group utilized the simplified optical navigation system, while the control group employed conventional C-arm fluoroscopic guidance. Each group contained 4 lumbar specimens, with percutaneous foraminal punctures performed bilaterally at the L2/3, L3/4, and L4/5 levels. Evaluation metrics(number of puncture attempts, fluoroscopy frequency and total puncture positioning time) were recorded and compared between groups.

All 48 lumbar transforaminal punctures (24 in each group) were successfully completed. The navigation group required significantly fewer puncture attempts (1.21 ± 0.51 vs. 5.13 ± 1.19) and fewer fluoroscopies (3.63 ± 0.77 vs. 12.88 ± 2.29) compared to the control group. However, the control group demonstrated shorter puncture positioning time (16.38 ± 2.58 min vs. 20.04 ± 1.68 min). The navigation group achieved a 79.17% first-attempt success rate. In the 5 unsuccessful initial attempts, fluoroscopy showed minimal deviation from the lumbar foramen, with all subsequent navigation-guided punctures being successful. The simplified optical navigation system required approximately 15 min for manual registration, demonstrated excellent stability without image lag or drift, and showed reliable performance with no system shutdowns or startup failures.

The simplified optical navigation system developed using optical tracking technology and 3D Slicer software can effectively assist percutaneous lumbar transforaminal puncture procedures. This navigation system provides direct visualization of the target anatomy, enables precise localization of puncture points and accurate adjustment of needle trajectories, thereby reducing procedural uncertainty and technical difficulty. The system significantly improves puncture accuracy while markedly decreasing both the number of puncture attempts and fluoroscopy exposures compared to conventional techniques.