Clinical Application Of Mixed Reality Navigation Combined With Percutaneous Transforaminal Endoscopic Discectomy In The Treatment Of Lumbar Intervertebral Disc Herniation

Objective: To investigate the feasibility and clinical efficacy of MR navigation combined with transforaminal spinal endoscopy in the treatment of lumbar disc herniation(LDH)by comparing the application of mixed reality(MR)technology navigation and traditional fluoroscopy-assisted transforaminal spinal endoscopy.Methods: A total of 40 patients with single-level unilateral symptomatic lumbar disc herniation were selected from April 2018 to April 2020,with disease course of 6months-6 years,with an average one of 18 months.Chief complaints included: low back pain,leg pain,low back and leg pain with radiating pain in the lower extremities,confirmed as lumbar disc herniation in combination with imaging studies,including X-ray,CT,and MRI,and treated conservatively with a complete system for at least 3months without significant relief of symptoms.The patients were divided into two groups: MR navigation PTED surgery group(group A)and C-arm fluoroscopy PTED surgery group(group B),20 cases for each group.There was no significant difference in age,gender and lesions between the two groups(P > 0.05).In group A,under local infiltration anesthesia,MR navigation was applied,percutaneous access was performed,and the protruding nucleus pulposus tissue was removed;the image data of three-dimensional reconstruction of lumbar CT of the patient was obtained preoperatively through the PACS system of the imaging department,the data were imported into the three-dimensional modeling of Mimics software,the three-dimensional model STL format file was generated,imported into the mixed reality platform to generate the MR application APP,and the precise surgical path was individualized and customized;the patient landmark points were calibrated intraoperatively,the mixed reality glasses were worn well,the immediate spatial anchor point of the mixed reality image was adjusted and fixed with the patient landmark point matching point,and then the image was fine-tuned until it completely overlapped and fused with the patient’s entity;the bore approach was punctured,the working channel was established,the trephine was applied to shape the bore step by step,the bore was placed,and the protruding nucleus pulposus was removed.Group B,local infiltration anesthesia,traditional fluoroscopy-assisted percutaneous hole approach using targeted puncture technique for nucleus pulposus removal and decompression.The intraoperative puncture evaluation indicators(puncture times,puncture time,fluoroscopy times,intraoperative pain score),evaluation indicators of general conditions(incision length,intraoperative blood loss,operation time,postoperative off-bed and postoperative hospital stay and surgical complications)of the two groups were compared,as well as the questionnaire survey indicators of the two groups,including preoperative and postoperative lumbar JOA score,VAS score,Oswestry disability index,to assess the clinical effect of MR navigation PTED in the treatment of LDH.Results: 40 patients had successful operation and were followed up for an average of 12 months(6-18 months).The symptoms of low back and leg pain in the two groups were significantly improved after operation.There was no intraoperative conversion to open surgery,intraoperative nerve injury,sac rupture,postoperative infection and other complications.There was no significant difference in the incision length,intraoperative blood loss,postoperative off-bed time and postoperative hospital stay between the two groups(P > 0.05).However,the indicators of puncture times,puncture time,fluoroscopy times,intraoperative pain score and operation time in the MR navigation PTED surgery group were superior to those in the C-arm fluoroscopy PTED surgery group,and the differences had statistical significance(P < 0.05).In terms of questionnaire indicators,the ODI,VAS and JOA of the two groups at each time point after operation were significantly improved(P < 0.05),and there was no significant difference in the ODI,VAS score and JOA score between the two groups at each time point(P > 0.05).Conclusions: Mixed reality navigation technique combined with percutaneous transforaminal endoscopic discectomy can safely and effectively treat LDH,and has equivalent clinical efficacy to traditional fluoroscopy-assisted transforaminal spinal endoscopic treatment of LDH.The former has fewer puncture times,puncture time and fluoroscopy times,less surgical trauma,high safety,minimally invasive and innovation.