経皮椎間孔内視鏡下椎間板摘出術における3次元仮想手術計画は精度と安全性を向上させる：後向き比較研究

Percutaneous transforaminal endoscopic discectomy (PTED) is efficacious for lumbar disc herniation but harbours a steep learning curve and considerable reliance on intraoperative fluoroscopy. This often results in prolonged procedural times and elevated radiation exposure, particularly for novice surgeons.

This study evaluates whether preoperative three-dimensional virtual planning using Mimics software improves procedural accuracy and reduces radiation exposure.

Sixty-five patients with single-level lumbar disc herniation (L1/2 to L5/S1) were allocated to two cohorts: a conventional group (n = 31) treated based on surgeon experience, and a 3D-planning group (n = 34) undergoing preoperative simulation of skin entry points and trajectories via Mimics. Primary outcomes included fluoroscopy frequency, number of puncture attempts, operative duration, and complication rates. Clinical outcomes (VAS, ODI) were documented as secondary measures.

The 3D-planning group demonstrated significantly reduced channel establishment time (15.39 ± 2.42 vs. 19.29 ± 5.98 min, P < 0.01), fewer intraoperative fluoroscopies (14.48 ± 2.66 vs. 18.56 ± 2.55 exposures, P < 0.01), and shorter endoscopic operating time (52.16 ± 12.54 vs. 75.09 ± 10.28 min, P < 0.01). Complication rates were lower in the 3D group (6.45% vs. 14.71%), though this difference did not reach statistical significance (P = 0.05). Both groups exhibited comparable improvements in VAS and ODI at 6-month follow-up.

Preoperative 3D virtual planning enhances procedural precision, reduces radiation exposure, and improves safety in PTED, proving particularly beneficial for surgeons during the initial learning curve.