Preoperative planning combining 3D reconstruction and body-surface meshing for percutaneous endoscopic lumbar discectomy in far lateral lumbar disk herniation.

BACKGROUND

Percutaneous endoscopic lumbar discectomy (PELD) is effective for far lateral lumbar disk herniation (FLLDH), requiring precise puncture. This study assessed 3D reconstruction combined with body-surface meshing for preoperative planning.

METHODS

This prospective randomized controlled trial enrolled 53 FLLDH patients (L4-5/L5-S1) from 2023 to 2024, who were randomized to Group A (n = 29; CT-based 3D-planning with surface grids) or Group B (n = 24; conventional X-ray planning). Outcomes included puncture time, operative time, fluoroscopy frequency, and Oswestry Dysfunction Index (ODI).

RESULTS

Baseline data were comparable (p > .05). Group A showed shorter puncture time (7.7 ± 2.1 min, 95% CI: 6.9-8.5 vs. 10.5 ± 3.8 min, 95% CI: 9.0-12.0), reduced operative time (48.7 ± 7.2 min, 95% CI: 46.2-51.2 vs. 55.2 ± 10.3 min, 95% CI: 51.0-59.4), and fewer fluoroscopy exposures (5.1 ± 1.9, 95% CI: 4.4-5.8 vs. 14.8 ± 3.9, 95% CI: 13.3-16.3; all p < .05). Both groups had improved ODI/VAS postoperatively (p < .05), with no intergroup clinical difference (p > .05).

CONCLUSIONS

3D reconstruction enhances puncture precision and reduces intraoperative fluoroscopy reduction in FLLDH-PELD, with clinical outcomes comparable to those of conventional methods.