Evaluation of Augmented Reality Surgical Navigation in Percutaneous Endoscopic Lumbar Discectomy: Clinical Study

Background: The puncture procedure in percutaneous endoscopic lumbar discectomy (PELD) is non-visual, and the learning curve for PELD is steep. Methods: An augmented reality surgical navigation (ARSN) system was designed and utilized in PELD. The system possesses three core functionalities: augmented reality (AR) radiograph overlay, AR puncture needle real-time tracking, and AR navigation. We conducted a prospective randomized controlled trial to evaluate its feasibility and effectiveness. A total of 20 patients with lumbar disc herniation treated with PELD were analyzed. Of these, 10 patients were treated with the guidance of ARSN (ARSN group). The remaining 10 patients were treated using C-arm fluoroscopy guidance (control group). Results: The AR radiographs and AR puncture needle were successfully superimposed on the intraoperative videos. The anteroposterior and lateral AR tracking distance errors were 1.55 +/- 0.17 mm and 1.78 +/- 0.21 mm. The ARSN group exhibited a significant reduction in both the number of puncture attempts (2.0 +/- 0.4 vs. 6.9 +/- 0.5, p = 0.000) and the number of fluoroscopies (10.6 +/- 0.9 vs. 18.5 +/- 1.6, p = 0.000) compared with the control group. Complications were not observed in either group. Conclusions: The results indicate that the clinical application of the ARSN system in PELD is effective and feasible.