The modified transforaminal endoscopic technique in treating intracanalicular combining foraminal and/or extraforaminal lumbar disc herniations

Abstract

Background: To develop a modified transforaminal endoscopic spine system (TESSYS ®) technique for treating intracanalicular combining foraminal and/or extraforaminal lumbar disc herniation (ICFE-LDH), and evaluate the technical efficacy and safety. Methods: Twenty-three patients with ICFE-LDH underwent the modified TESSYS technique were enrolled. Magnetic resonance imaging (MRI) was used to verify the reduction of herniated disc. Pre-and post-operative neurological functions were compared by visual analogue scale (VAS) score, Oswestry disability index (ODI) and the modified MacNab criteria. The technical safety was evaluated by surgical complications. Results: MRI demonstrated reductions of disc herniations in 22 patients (95.7%) after surgeries. The VAS scores were significantly improved at 1 year follow-up (low back: P=0.001, lower limbs: P<0.001), as well as ODI scores (P<0.001). 22 patients had achieved excellent and good recovery postoperatively according to the modified MacNab criteria. One patient (4.3%) underwent a reoperation due to postoperative recurrence of disc herniation. Another patient complained postoperative causalgia in 8 weeks, the symptom alleviated after conservative treatment at 1 year follow-up (VAS: back, 3, lower limbs, 0; ODI: 20%). The incidence rate of surgical complication was 8.7%. Conclusions: The modified TESSYS technique is a minimally-invasive, effective and safe surgery for treating ICFE-LDHs in selected patients.

Comparison of the application value of two commonly used minimally invasive spinal surgery in the treatment of lumbar disc herniation

“…PTED and MED are two kinds of minimally invasive spinal surgery commonly used nowadays. Compared with traditional open surgery, both of them can ensure the clinical efficacy equivalent to traditional open surgery and have the advantages of minimally invasive surgery (7,9). In the present study, we first analyzed the advantages and disadvantages of PTED and MED in perioperative period.…”

“…PTED is a combination of endoscopic technology and percutaneous puncture technology, which can establish a working channel under local anesthesia through the intervertebral foramen approach, the intervertebral space approach or the lateral approach of the intervertebral foramen to remove the protruding nucleus (6). PTED, as a common surgical method in minimally invasive spine surgery, has the advantages of being minimally invasive, small incision and fast recovery, and can obtain the same clinical effect as traditional open surgery (7). MED is based on traditional open surgery and microsurgery, and it is basically the same as that of open surgery (8).…”

Comparable effectiveness of transforaminal endoscopic spine system technique combined with selective nerve root block between far lateral lumbar disc herniation and central or paracentral herniation

“…In our practice, to avoid nerve root damage and improve the comfort of the operation, the traditional decompression mode "from the inside-out" process can be broken during the treatment under the transforaminal endoscope, and change to the decompression mode of “from outside-to-inside”, which has also been confirmed by other scholars. [ 31 , 32 ]…”

Percutaneous transforaminal endoscopic discectomy for different types of lumbar disc herniation: A retrospective study

“…The conventional transforaminal endoscopic surgical system can safely and effectively treat LDH, but the inside-out approach still presents difficulties in some aspects. 23 When the working channel is placed in the centre of the spinal canal, the soft tissue is not easily distinguished in the first view of the endoscope. The loss of spatial orientation can easily cause nerve damage.…”