Three-Dimensional Reconstruction–Guided Development of a Percutaneous Endoscopic Lumbar Disc Positioning Device in a Porcine Spine Model

Summary

The percutaneous endoscopic intervertebral disc positioning device developed in this study can assist in the positioning of intervertebral discs. This device reduces radiation exposure and supports technical training for young spinal surgeons.

Abstract

Lumbar disc herniation (LDH) is commonly caused by annular disruption resulting from trauma or poor posture, leading to extrusion of nucleus pulposus material and compression of lumbar nerve roots. This condition often presents with radicular pain and sensory disturbances radiating from the lower back to the lower extremities. Although most cases can be managed conservatively, severe or refractory symptoms may require surgical intervention, including conventional discectomy, minimally invasive microscopic discectomy, and endoscopic discectomy. Percutaneous endoscopic lumbar discectomy (PELD) can be performed under local anesthesia; however, the procedure relies heavily on the surgeon's experience and is associated with technical challenges, including positioning difficulty, repeated fluoroscopic confirmation, and increased radiation exposure. The objective of this study was to develop and evaluate a novel percutaneous endoscopic lumbar disc positioning device designed to improve the precision and efficiency of disc positioning during PELD. This study developed a unique percutaneous endoscopic lumbar disc positioning device. The device was realized through the reconstruction and repair of 3D models of the porcine spine and lumbar spine, fabrication of a convex base plate, design of spinal spinous process and disc positioning guiding devices, computer-aided design of a percutaneous endoscopic lumbar disc minimally invasive surgical navigation module, and accuracy testing. Experimental results showed that the device could accurately locate positions on porcine spines and may reduce fluoroscopic dependence in experimental settings. The positioning device provided high precision, supporting minimally invasive surgery by reducing incision size, avoiding damage to surrounding critical blood vessels and nerve tissues, and offering multi-directional surgical instrument guiding paths, facilitating the surgical process. The percutaneous endoscopic lumbar disc positioning device described in this study provides a structured, reproducible approach to intervertebral disc positioning during PELD. This method has the potential to improve procedural efficiency, limit radiation exposure, and support surgical training, particularly for early-career spine surgeons.

Introduction

Lumbar disc herniation (LDH) involves the extrusion of the nucleus pulposus through an annular defect into the spinal canal or neural foramen, resulting in lumbar nerve root compression. Clinical symptoms such as sharp pain, leg cramps, and numbness are presented, and even muscle weakness, atrophy, urinary and fecal incontinence can occur as permanent sequelae¹. Although most patients respond to conservative treatment, surgical intervention is required for those with refractory symptoms or progressive neurological impairment.

Several surgical techniques have been developed for the management of severe LDH, including ....

Protocol

The porcine spine samples used in this article were procured from local commercial markets. Because these samples came from animals slaughtered for food purposes and without any live animal handling, they did not require review and approval by the Institutional Animal Care and Use Committee (IACUC).

This study developed a unique percutaneous endoscopic lumbar disc positioning device by reconstructing and refining three-dimensional (3D) models of the porcine spine specimens and lumbar spine simulation models. This device includes the guiding device, the navigation module, and the positioning device. The entire system was validated through po....

Results

Using the reconstructed 3D model of the lumbar simulated bone model (Figure 1), with the positioning information of the anterior superior iliac spine (ASIS) and spinous process, we designed the "Percutaneous Endoscopic Lumbar Intervertebral Disc Positioning Device" (Figure 2). Initially, a scaled-down physical model was printed using FDM 3D printing technology (Figure 3) to verify structural feasibility. It was observed that the K-w.......

Discussion

This study presents a protocol for the development and application of a Percutaneous Endoscopic Lumbar Intervertebral Disc Positioning Device designed to facilitate reliable positioning of the intended intervertebral disc space, as confirmed by fluoroscopic imaging, reduce operative time, and potentially improve patient outcomes in PELD. We integrated medical imaging, 3D reconstruction, and additive manufacturing to establish an external navigation framework based on reproducible anatomical reference lan.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
AutoCAD (CAD software)	Autodesk	https://www.autodesk.com/	Used for device and navigation module design
Fused deposition modeling (FDM) 3D printer	Stratasys	N/A	Used for fabrication of the device and models
Lumbar spine simulation model (L3–sacrum)	Sawbones	1340-20	Used for device design and procedural simulation
MATLAB (3D reconstruction software)	MathWorks	https://in.mathworks.com/	Used for 3D reconstruction from DICOM images