Abstract
ObjectivePercutaneous transforaminal endoscopic discectomy (PTED) is minimally invasive and has been widely used to treat patients with lumbar disc herniation (LDH) due to its safety and efficiency. However, due to the unique anatomy of the L5–S1 level, the PTED procedure is often difficult to perform in the region. ZESSYS, a targeted and quantificational foraminoplasty device, may help to overcome these anatomical limitations. In this study, we assessed the efficiency and the short-term effects of PTED with ZESSYS at the L5–S1 level.MethodsBetween January and August of 2018, fifty-six patients with lumbar disc herniation at the single level of L5–S1 and who underwent percutaneous transforaminal endoscopic discectomy were enrolled in this retrospective cohort study. They were segregated into the transforaminal endoscopic surgical system (TESSYS) group and the ZESSYS group. The puncture time, foraminoplasty time, decompression time, and fluoroscopy time were evaluated for operation efficiency. Clinical outcomes were assessed by the visual analog scale (VAS) score and Oswestry Disability Index (ODI) score. The MacNab criteria were used to evaluate patient subjective satisfaction at 12-month follow-up postoperatively.ResultsThe average puncture time (5.29 ± 2.05 min), foraminoplasty time (12.82 ± 2.52 min), and fluoroscopy time (26.29 ± 5.96 s) were all significantly shorter in the ZESSYS group than in the TESSYS group (average puncture time 8.07 ± 3.13 min, p < 0.01; foraminoplasty time, 17.18 ± 2.92 min, p < 0.01; fluoroscopy time, 34.73 ± 6.86 s; p < 0.01). No significant differences were observed between the 2 groups in the decompression time (p = 0.057). The VAS score of low back pain and leg pain, as well as the ODI score, improved at all time points postoperatively compared with preoperative, in both the TESSYS group and the ZESSYS group (P < 0.05). There were no significant differences in the VAS score of low back pain, VAS score of leg pain, and ODI score between the TESSYS group and the ZESSYS group at the same time points (P > 0.05). According to the MacNab criteria, the excellent and good rate at 12-month follow-up postoperatively was 85.7% in the TESSYS group and 89.3% in the ZESSYS group (P > 0.05).ConclusionThe targeted and quantificational foraminoplasty device named ZESSYS was more efficient in the puncture and foraminoplasty procedures, effectively protecting the exiting nerve and minimizing the level of radiation exposure. The device is efficient and safe for PTED in treating lumbar disc herniation at the L5–S1 level.
Highlights
Lumbar disc herniation (LDH) is a frequently occurring disease of the spine and leads to economic and medical burdens on families and society [1, 2]
There were no significant differences in the visual analog scale (VAS) score of low back pain, VAS score of leg pain, and Oswestry Disability Index (ODI) score between the transforaminal endoscopic surgical system (TESSYS) group and the ZESSYS group at the same time points (P > 0.05)
The targeted and quantificational foraminoplasty device named ZESSYS was more efficient in the puncture and foraminoplasty procedures, effectively protecting the exiting nerve and minimizing the level of radiation exposure
Summary
Lumbar disc herniation (LDH) is a frequently occurring disease of the spine and leads to economic and medical burdens on families and society [1, 2]. In recent decades, percutaneous transforaminal endoscopic discectomy (PTED), via a posterolateral approach, has gained popularity in clinical practice due to advantages such as little trauma, few scar, a rapid recovery, and a short hospital stay [5,6,7,8,9] For this minimally invasive surgery, a working cannula with a diameter of 7.5 mm needs to be introduced safely to the space in front of the spinal dural sac via the posterolateral direction, and foraminoplasty often needs to be performed to enlarge the intervertebral foramen. At the L5–S1 level, the unique anatomy involving a high iliac crest, sacral ala, large facet joint, large L5 transverse process, narrowed disc space, and narrowed foramen can complicate the foraminoplasty process These anatomical obstacles and inter-individual variability in the anatomy make PTED technically challenging [12]. PTED is more difficult to perform at this level in particular [13], even for skilled and experienced surgeons
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