Patient-Specific Virtual Reality Rehearsal for Technically Challenging Lumbar Transforaminal Epidural Steroid Injection: A Pilot Randomized Controlled Trial.

PURPOSE: Lumbar transforaminal epidural steroid injection (TFESI) can be technically challenging in patients with complex spinal anatomy. This pilot study aimed to evaluate whether patient-specific three-dimensional (3D) virtual reality (VR) rehearsal generated from pre-procedural CT images improves procedural performance during anatomically challenging lumbar TFESI.

PATIENTS AND

METHODS

This prospective, single-center, randomized controlled trial included 30 patients scheduled for technically challenging lumbar TFESI. Participants were randomly assigned to either the control group (n = 15) or the VR group (n = 15). In the VR group, patient-specific 3D models were generated from pre-procedural lumbar CT images and the operator performed VR rehearsal one day before the procedure. In the control group, pre-procedural CT images and, when available, magnetic resonance imaging findings were reviewed before the procedure. All procedures were performed by a single experienced pain specialist. The primary outcomes were procedure time and the number of fluoroscopic image acquisitions. Secondary outcomes included needle-bone contacts, intravascular contrast uptake, patient satisfaction, and procedure completion.

RESULTS

All patients received the allocated intervention and were included in the final analysis. Procedure time was shorter in the VR group than in the control group (215.7 ± 46.8 sec vs 254.5 ± 50.3 sec; mean difference, -38.9 sec; 95% CI, -75.2 to -2.5; p = 0.037). The number of fluoroscopic image acquisitions was also lower in the VR group (10.27 ± 2.74 vs 13.27 ± 3.65 images; mean difference, -3.00 images; 95% CI, -5.41 to -0.59; p = 0.017). The number of needle-bone contacts was numerically lower in the VR group, although this difference was not statistically significant (1.3 ± 1.1 vs 2.1 ± 1.3, p = 0.081). Patient satisfaction and intravascular contrast uptake did not differ significantly between groups. All procedures were completed as planned.

CONCLUSION

In this pilot study, patient-specific VR rehearsal before technically challenging lumbar TFESI was associated with shorter procedure time and fewer fluoroscopic image acquisitions. These preliminary findings support further evaluation of patient-specific VR rehearsal as a useful pre-procedural planning tool for anatomically challenging TFESI cases.