• Chaoshun Zheng, Jiajun Li, Gang Zeng, Wei Ye, Jianchao Sun, Junmin Hong, and Chunhai Li.
• Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
• World Neurosurg. 2019 Mar 1; 123: e1-e8.

ObjectivePercutaneous endoscopic lumbar discectomy is an effective way to treat lumbar disc herniation. Traditional preoperative planning based on a 2-dimensional method by magnetic resonance/computed tomography may cause inaccuracy of puncture during surgery. We used virtual reality to stimulate a surgery environment and measured relevant 3-dimensional data. We then explored its applicability for increasing puncture accuracy during actual surgeries.MethodsA prospective randomized trial of lumbar disc herniation was conducted. Both conventional and virtual reality methods were used for preoperative planning and relevant data (planned puncture point and entry angle) were measured. Data were used during surgery and adjusted to complete the operation. The final entry point and entry angle were recorded and compared with relevant planned data statistically. Fluoroscopic times and location time also were included to access the puncture accuracy during surgery.ResultsThirty cases were included in our study. Both groups achieved good results after surgery, except for 1 case of postoperative dysesthesia in the traditional planning group and 1 case of residual disc in the virtual reality group. The use of virtual reality can predict a surgery-related angle and distance accurately except for depth. Compared with the traditional planning group, the fluoroscopic time (13.18 ± 4.191 vs. 32.00 ± 4.52) and location time (17.91 ± 4.74 vs. 33.22 ± 3.90) were statistically different, which indicates that this method can increase puncture accuracy.ConclusionsA virtual reality planning system is an accurate preoperative planning method that can significantly improve the puncture accuracy of percutaneous endoscopic lumbar discectomy and reduce fluoroscopic and location times.Copyright © 2018. Published by Elsevier Inc.

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