Abstract
BackgroundWe designed an easy posterolateral transforaminal endoscopic decompression technique, termed PTES, for radiculopathy secondary to lumbar disc herniation. The purpose of the study is to describe the technique of PTES and evaluate the efficacy and safety for treatment of lumbar disc herniation including primary herniation, reherniation, intracanal herniation, and extracanal herniation and to report outcome and complications.MethodsPTES was performed to treat 209 cases of intracanal or extracanal herniations with or without extruding or sequestrated fragment, high iliac crest, scoliosis, calcification, or cauda equina syndrome including recurrent herniation after previous surgical intervention at the index level or adjacent disc herniation after decompression and fusion. Preoperative and postoperative leg pain was evaluated using the 10-point visual analog scale (VAS) and the results were determined to be excellent, good, fair, or poor according to the MacNab classification at 2-year follow-up.ResultsThe patients were followed for an average of 26.3 ± 2.3 months. The VAS score of leg pain significantly dropped from 9 (6–10) before operation to 1 (0–3) (P < 0.001) immediately after the operation and to 0 (0–3) (P < 0.001) 2 years after operation. At 2-year follow-up, 95.7% (200/209) of the patients showed excellent or good outcomes, 2.9% (6/209) fair and 1.4% (3/209) poor. No patients had any form of permanent iatrogenic nerve damage and a major complication, although there were one case of infection and one case of recurrence.ConclusionsPTES for lumbar disc herniation is an effective and safe method with simple orientation, easy puncture, reduced steps, and little X-ray exposure, which can be applied in almost all kinds of lumbar disc herniation, including L5/S1 level with high iliac crest, herniation with scoliosis or calcification, recurrent herniation, and adjacent disc herniation after decompression and fusion. The learning curve is no longer steep for surgeons.
Highlights
We designed an easy posterolateral transforaminal endoscopic decompression technique, termed posterolateral endoscopic discectomy (PTES), for radiculopathy secondary to lumbar disc herniation
Most kinds of disc herniations are accessible for treated with posterior lateral endoscopic discectomy (TESS) of outside disc-inside technique directly into the spinal canal [2, 3], complexity of C-arm guided orientation, difficulty to find the optimal trajectory for target, and more steps of surgical manipulation leaded to much exposure of X-ray, long duration of operation, and steep learning curve
The purpose of the study is to describe the technique of PTES and evaluate the efficacy and safety for treatment of lumbar disc herniation including primary herniation, reherniation, intracanal herniation, and extracanal herniation and to report outcome and complications
Summary
We designed an easy posterolateral transforaminal endoscopic decompression technique, termed PTES, for radiculopathy secondary to lumbar disc herniation. As a minimally invasive surgical technique, the posterior lateral transforaminal endoscopic surgery has been developed to perform discectomy for neurologic decompression under direct view and local anesthesia including YESS (Yeung Endoscopy Spine Surgery) [1,2,3,4,5] and TESS (Transforaminal Endoscopic Spine Surgery) [6,7,8,9,10,11]. We designed an easy posterolateral transforaminal endoscopic decompression technique for radiculopathy secondary to lumbar disc herniation, termed PTES (percutaneous transforaminal endoscopic surgery). The purpose of the study is to describe the technique of PTES and evaluate the efficacy and safety for treatment of lumbar disc herniation including primary herniation, reherniation, intracanal herniation, and extracanal herniation and to report outcome and complications
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