Whole process navigated percutaneous endoscopic lumbar discectomy guided by a novel X-ray instant navigation: a technical report and preliminary clinical outcomes.

OBJECTIVE: In this study, we established a rapid whole-process Percutaneous Endoscopic Lumbar Discectomy(PELD) surgical workflow guide by a novel X-ray instant Navigation(XIN)based on permanent calibration and specialized instruments. The safety and efficacy of this technique were evaluated through clinical application on surgical treatment in patients with lumbar disc herniation. METHODS: From June 2023 to February 2024, 44 patients with lumbar disc herniation underwent PELD guided by XIN system. A retrospective review of clinical data was conducted, including navigation preparation time, cannulation time, total operative time, intraoperative fluoroscopy exposure, and hospital stay duration. Outcomes were assessed using the Visual Analog Scale (VAS) for back and leg pain, the Oswestry Disability Index (ODI) for functional status, and the modified MacNab criteria for overall efficacy. RESULTS: The average surgical time was 50.29 min (range: 32-71 min), with an average navigation preparation time of 2.57 min and cannulation placement time of 12.70 min. The average postoperative hospital stay was 1.39 days (range: 1-3 days). The average intraoperative fluoroscopy count was 3.41 times. At the final follow-up, significant improvements were observed in both the VAS scores for back and leg pain and ODI functional impairment index compared to preoperative values, with statistically significant differences (P < 0.001). According to the Modified MacNab criteria,27 cases (61.4%) were rated as excellent, 13 cases (29.5%) as good, 3 cases (6.8%) as fair, and 1 patients (2.3%) as poor, resulting in an overall excellent/good rate of 90.9%. No cases of nerve root injury or deep infection occurred. CONCLUSION: We developed a whole process navigated PELD technique, incorporating specialized instruments and a streamlined procedural workflow based on X-ray instant navigation (XIN). Preliminary clinical results demonstrate that this technique is safe, efficient, and effective.