Study Overview and Context
A 2026 study published in *Orthopaedic Surgery* compared two approaches to percutaneous transforaminal endoscopic discectomy (PTED) for lumbar disc herniation (LDH). The research evaluated the clinical performance, safety, and procedural efficiency of two-dimensional (2D) electromagnetic navigation versus three-dimensional (3D) electromagnetic navigation. The study involved 82 patients with LDH who underwent PTED between January 2022 and June 2024. Patients were divided into two groups based on the navigation system used during surgery. The primary goal was to assess differences in operative time, radiation exposure, learning curves, and clinical outcomes. The findings aim to inform surgical decision-making by highlighting potential advantages of simplified navigation systems in spinal procedures.
Methods and Patient Population
The retrospective cohort study included 82 patients with lumbar disc herniation who underwent PTED at a single institution. Participants were assigned to either the 2D or 3D electromagnetic navigation group based on the surgical workflow employed. Perioperative data, including total operative time, navigation registration time, radiation exposure, and complications, were recorded. Clinical outcomes were measured using the Visual Analogue Scale (VAS) for back and leg pain, the Oswestry Disability Index (ODI), and modified MacNab criteria. The learning curves for surgeons and radiologic technologists were analyzed using cumulative sum (CUSUM) methods. The study design did not specify randomization or blinding, and the sample size was limited to a single center, which may affect generalizability.
Key Findings
The 2D electromagnetic navigation group demonstrated significantly shorter total operative times (66.64 ± 9.67 minutes vs. 88.92 ± 15.98 minutes) and navigation registration times (6.37 ± 0.93 minutes vs. 12.25 ± 2.11 minutes) compared to the 3D group. Radiation exposure was also lower in the 2D group (1.77 ± 0.17 mGy vs. 7.24 ± 0.56 mGy). Both groups showed significant postoperative improvements in VAS scores for back and leg pain, as well as ODI, with no significant differences in final clinical outcomes based on the modified MacNab criteria. The 2D group achieved proficiency in the learning curve earlier, with surgeons reaching competence by the 16th case and radiologic technologists by the 14th case, compared to the 3D group. No significant differences in complication rates were observed between the groups.
Clinical Outcomes and Recovery Patterns
Longitudinal analysis revealed significant improvements in postoperative outcomes for both groups, with no major differences in overall clinical effectiveness. While the 2D and 3D groups showed similar final results, the 2D approach exhibited distinct recovery patterns for back pain and ODI scores over time. The group-by-time interaction was significant for VAS of back pain (p = 0.007) and ODI (p < 0.001), indicating variations in recovery trajectories. However, both techniques achieved substantial pain reduction and functional improvement. The study concluded that 2D navigation offered greater procedural efficiency, reduced radiation exposure, and a shorter learning curve without compromising safety or clinical outcomes. These findings suggest that 2D systems may be more practical for routine clinical use, particularly in settings with resource constraints.
Study Limitations and Implications
The study’s retrospective design and single-center focus limit its generalizability. The authors noted that larger, multicenter trials are needed to validate these findings across diverse patient populations and surgical environments. While the 2D approach demonstrated clear advantages in efficiency and safety, the study did not address long-term outcomes or potential differences in patient-reported satisfaction. The authors emphasized that both techniques remain viable options for LDH treatment, with the choice depending on institutional resources, surgeon experience, and patient-specific factors. The results highlight the potential for simplified 2D navigation systems to enhance surgical workflows while maintaining clinical efficacy, though further research is required to confirm these benefits in broader contexts.