Navigation improves the learning curve of transforamimal percutaneous endoscopic lumbar discectomy

Purpose Beginners usually need increased punctures and dozens of fluoroscopy in learning transforamimal percutaneous endoscopic lumbar discectomy (tPELD). Navigator-assisted spinal surgery (NASS) is a novel technique that could induce a definite trajectory. The retrospective study aimed to investigate the impact of a definite trajectory on the learning curve of tPELD. Methods A total of 120 patients with symptomatic lumbar disc herniation who received tPELD between 2012 and 2014. Patients receiving tPELD with NASS technique by one surgeon were regarded as group A, and those receiving conventional methods by another surgeon were regarded as group B. Each group was divided into three subgroups (case 1-20, case 21-40, case 41-60). Results The fluoroscopy times were 22.62 +/- 3.80 in group A and 34.32 +/- 4.78 in group B (P < 0.001). The pre-operative location time was 3.56 +/- 0.60 minutes in group A and 5.49 +/- 1.48 minutes in group B (P < 0.001). The puncture-channel time was 21.85 +/- 4.31 minutes in group A and 34.20 +/- 8.88 minutes in group B (P < 0.001). The operation time was 84.62 +/- 9.20 minutes in group A and 101.97 +/- 14.92 minutes in group B (P < 0.001), and the learning curve of tPELD in group A was steeper than that in group B. No significant differences were detected in patient-reported outcomes, hospital stay, patient satisfaction, and complication rate between the two groups (p > 0.05). Conclusions Definite trajectory significantly reduced the operation time, preoperative location time, puncture-channel time, and fluoroscopy times of tPELD by beginners, and thus reshaped the learning curve of tPELD and minimized the radiation exposure.