445: Comparison of the Effects of VR Simulation Before Lumbar Transforaminal Epidural Steroid Injections

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary musculoskeletal pain, Developing methodology/technology, Digital Health Technologies , Treatment/management

Background and Aims: Lumbar Transforaminal Epidural Steroid Injection (TFESI) can be challenging due to anatomical variations, posing risks, especially for novices. While virtual reality (VR) simulation is emerging, research on using patient-specific data for pre-procedural TFESI practice remains limited. We evaluated the effect of patient-specific 3D VR simulation on challenging lumbar TFESI performance.

Methods: In this prospective randomized controlled trial, we developed software to convert patient DICOM images into 3D VR models and VR based on a TFESI simulator. Patients requiring challenging TFESI were randomized to either pre-procedural VR simulation (VR group) or conventional image review (control group). A single experienced specialist performed all procedures. We compared procedure time, needle-bone contacts, intravascular injection rates, and patient satisfaction.

Results: The VR simulation group showed a significantly shorter procedure time (254.5 ± 50.3 vs. 215.7 ± 46.8, -38.87 ± 17.74; p=0.037) and reveals lower fluoroscopy count (13.3 ± 3.7 vs. 10.27 ± 2.7, -2.733 ± 1.217; p=0.033). Results also showed fewer needle-bone contacts compared to the control group (2.1 ± 1.3 vs. 1.3 ± 1.1, p=0.081) but it wasn’t statistically significant. There were no significant differences between the two groups in terms of patient satisfaction, presence of a intravascular injection.

Conclusions: Pre-procedural, patient-specific VR simulation improved proficiency in challenging TFESI by reducing procedure time and bone contacts, even for an experienced physician. VR simulation serves as a practical adjunct for experienced clinicians to plan complex cases, potentially enhancing patient safety. Further research with multiple operators and diverse patient population is necessary to confirm these findings.

References: 1. Candido KD. Transforaminal Versus Interlaminar Approachesto Epidural Steroid Injections: A SystematicReview of Comparative Studies for LumbosacralRadicular Pain. Pain Physician. 2014;4;17(4;7):E509-E524. doi:10.36076/ppj.2014/17/E509
2. Kaufmann TJ, Geske JR, Murthy NS, et al. Clinical Effectiveness of Single Lumbar Transforaminal Epidural Steroid Injections. Pain Med. 2013;14(8):1126-1133. doi:10.1111/pme.12122
3. Goh GS, Lohre R, Parvizi J, Goel DP. Virtual and augmented reality for surgical training and simulation in knee arthroplasty. Arch Orthop Trauma Surg. 2021;141(12):2303-2312. doi:10.1007/s00402-021-04037-1
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Presenting Author: Sunmin Kim
Submitting Author: Sunmin Kim

Senior Author: Jae Chul Koh

IASP 2026 Global Year theme of Neuropathic Pain: No

• Jae Chul Koh: M.D., Ph.D. - Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea