Percutaneous Transforaminal Discectomy Research Articles

Complications and Management of Endoscopic Spinal Surgery.

In the past, the use of endoscopic spine surgery was limited to intervertebral discectomy; however, it has recently become possible to treat various spinal degenerative diseases, such as spinal stenosis and foraminal stenosis, and the treatment range has also expanded from the lumbar spine to the cervical and thoracic regions. However, as endoscopic spine surgery develops and its indications widen, more diverse and advanced surgical techniques are being introduced, and the complications of endoscopic spine surgery are also increasing accordingly. We searched the PubMed/MEDLINE databases to identify articles on endoscopic spinal surgery, and key words were set as "endoscopic spinal surgery," "endoscopic cervical foramoinotomy," "PECD," "percutaneous transforaminal discectomy," "percutaneous endoscopic interlaminar discectomy," "PELD," "PETD," "PEID," "YESS" and "TESSYS." We analyzed the evidence level and classified the prescribed complications according to the literature. Endoscopic lumbar surgery was divided into full endoscopic interlaminar and transforaminal approaches and a unilateral biportal approach. We performed a comprehensive review of available literature on complications of endoscopic spinal surgery. This study particularly focused on the prevention of complications. Regardless of the surgical methods, the most common complications related to endoscopic spinal surgery include dural tears and perioperative hematoma. transient dysesthesia, nerve root injury and recurrence. However, Endoscopic spinal surgery, including full endoscopic transforaminal and interlaminar and unilateral biportal approaches, is a safe and effective a treatment for lumbar as well as cervical and thoracic spinal diseases such as disc herniation, lumbar spinal stenosis, foraminal stenosis and recurrent disc herniation.

Comparison of Three Common Intervertebral Disc Discectomies in the Treatment of Lumbar Disc Herniation: A Systematic Review and Meta-Analysis Based on Multiple Data.

Due to recent developments and the wide application of percutaneous transforaminal discectomy (PTED), we herein compare it with microendoscopic discectomy (MED) and traditional open surgery (OD) through surgical indicators and postoperative outcomes to evaluate the advantages and disadvantages of minimally invasive surgery PTED. This systematic review and meta-analysis was conducted in line with PRISMA guidelines (PROSPERO2018: CRD42018094890). We searched four English and two Chinese databases from the date of their establishment to May 2022. Randomized controlled trials and case-control studies of PTED versus MED or PTED versus OD in the treatment of lumbar disc herniation were retrieved. A total of 33 studies with 6467 cases were included. When comparing MED with PTED, the latter had less intraoperative blood loss, smaller incision, shorter postoperative bed times, shorter hospitalization times, better postoperative visual analogue scale (VAS) for low back pain, and postoperative dysfunction index (Oswestry Disability Index, ODI) and higher recurrence rates and revision rates. However, operation times, postoperative VAS leg scores and complications, and successful operation rates were similar in both groups. Comparison of PTED with OD revealed in the former less intraoperative blood loss and smaller incision, shorter postoperative bed times, shorter hospitalization times, shorter operation times, and higher recurrence rates and revision rates. Nonetheless, comprehensive postoperative VAS scores, VAS leg pain scores, VAS low back pain, ODI and incidence of complications, and successful operation rates were similar between the two groups. The therapeutic effect and safety of PTED, MED and OD in the treatment of lumbar disc herniation were comparable. PTED had obvious advantages in that it is minimally invasive, with rapid recovery after surgery, but its recurrence rates and revision rates were higher than MED and OD. Therefore, it is not possible to blindly consider replacing MED and OD with PTED.

Is It Possible to Replace Microendoscopic Discectomy with Percutaneous Transforaminal Discectomy for Treatment of Lumbar Disc Herniation? A Meta-Analysis Based on Recurrence and Revision Rate.

ObjectivesDue to recent developments and the wide application of percutaneous transforaminal discectomy (PTED) in China, we herein compare its clinical effects with microendoscopic discectomy (MED) for the treatment of lumbar disc herniation in terms of recurrence and revision rates. MethodsSix databases, namely, PubMed, EMBASE, Cochrane Library, Ovid, China National Knowledge Infrastructure and Wanfang, were searched by computer. The literature was screened according to inclusion and exclusion criteria, and the quality of the included literature was evaluated. After extracting the data from the papers, Review Manager 5.2 software (Cochrane Collaboration, Oxford, UK) was applied to analyze these data. Finally, sensitivity and publication bias analyses of the results were conducted. ResultsA total of 12 studies consisting of 2400 patients were included in this meta-analysis. A comparison of PTED with MED revealed higher postoperative recurrence and postoperative revision rates for PTED (odds ratio [OR] recurrence, 1.60; 95% confidence interval [CI], 1.01 to 2.53; p=0.05 and OR revision, 1.77; 95% CI, 1.18 to 2.64, p=0.006). ConclusionPTED has a number of advantages because it is a minimally invasive surgery, but its recurrence and revision rates are higher than MED. Therefore, MED should not be completely replaced by PTED.

Treatment of L₄,₅ lumbar disc herniation with percutaneous endoscopic lumbar discectomy through two different approaches

To analyze the clinical efficacy, indications and operative points of transforaminal approach and interlaminar approach in the treatment of L₄,₅ lumbar disc herniation. A retrospective analysis was performed on 48 patients with L₄,₅ lumbar disc herniation treated by percutaneous endoscopic lumbar discectomy from November 2016 to June 2018. Among them, 32 patients underwent percutaneous endoscopic transforaminal discectomy(PETD), including 17 males and 15 females, with an average age of (60.22±16.55) years, and the course of disease was(2.18±2.68) months;16 patients underwent percutaneous endoscopic interlaminar discectomy(PEID), including 7 males and 9 females, with an average age of (42.25±15.89) years, and the course of disease was(2.90±3.02) months. VAS, ODI of two groups before operation, 3 days, 3 months, and 6 months after operation were analyzed, and modified Macnab standard was used to evaluate the clinical effects. All the 48 patients successfully completed the surgical treatment, and all patients were followed up. There was no significant difference in gender, course of disease and follow-up time between two groups (P>0.05). The age of PETD group was(60.22±16.55) years and PEID group was (42.25±15.89) years, there was statistical difference between two groups (P<0.05 ). In the PETD group, there were 10 patients with advanced age, non-free type(24 cases) was more than free type(8 cases), and shoulder type(27 cases) more than axillary type(1 case) and ventral type(4 cases). PETD was used in 5 patients with lateral type and 2 patients with extreme lateral type. In PEID group, the axillary type(8 cases) was more than the shoulder type(2 cases) and the ventral type(6 cases), PEID was used in 4 patients with high prolapse free type(I and IIregions). VAS scores and ODI of patients in two groups at each postoperative follow-up point were significantly improved compared with those before surgery(P<0.05). According to modified Macnab standard to evaluate the clinical effect, in PETD group, 24 cases obtained excellent results, 5 good, 2 fair, 1 poor, while in PEID group, 12 excellent, 3 good, 0 fair, 1 poor. Both two surgical approachs can achieve satisfactory efficacy in treating L₄,₅ lumbar disc herniation, but PETD is more suitable for elderly patients, non-free type, lateral type, extremely lateral type and shoulder type of lumbar disc herniation. High prolapse(I and II regions) and axillary type lumbar prominent should select PEID.

Necessity of routinely performing foraminoplasty during percutaneous endoscopic transforaminal discectomy in treating lumbar disc herniation

Objective To analyze the necessity of routinely performing foraminoplasty during percutaneous transforaminal endoscopic discectomy (PETD). Methods A total of 412 patients including 231 males and 181 females with an average age of 39.1±13 (20-80) years were enrolled in the present study. All patients were preoperatively diagnosed with single-segment lumbar disc herniation and underwent PETD by the same surgical group. The affected segments were at L3-4 in 32 cases, L4-5 in 289 cases, and L5S1 in 91 cases. Among them, 306 cases had no prolapse, 89 had mild up/down prolapse, and 17 had severe prolapse. MRI sagittal imaging was used to measure the height and width of the intervertebral foramen of L3, 4, L4, 5 and L5S1 segments, the distance between the lower edge of vertebral pedicle and the upper edge of the lower vertebral pedicle and the distance between the point 3 mm to the ventral side of the intervertebral space to the superior articular process. The necessity of performing foraminoplasty was evaluated by measuring the change of intervertebral foramen width using dynamic X-ray and verified during operation. Results The height of the intervertebral foramen of L3,4, L4,5 and L5S1 segments were 1.99±0.25, 1.89±0.15 and 1.52±0.26 cm, respectively. The width of the intervertebral foramen was 0.78±0.14, 0.75±0.13 and 0.64±0.13 cm, respectively. The distance between the lower edge of vertebral pedicle and the upper edge of the lower vertebral pedicle were 1.14±0.17, 1.05±0.16, and 0.98±0.19 cm, respectively. The distance between the point 3 mm to the ventral side of the intervertebral space to the superior articular process were 1.11±0.31, 1.17±0.20, and 0.95±0.14 cm, respectively. The width of the intervertebral foramen of the L3, 4 and L4,5 segments was significantly greater at the over-flexion position than at the over-extension position (P<0.05). Intraoperative verification showed that 347 cases (group A) did not need foraminoplasty. However, the other 65 patients (group B) needed foraminoplasty, including 31 at L4, 5 segment and 34 at L5S1 segment. One patient in group A and one in group B underwent revision operation due to residual intervertebral disc. At 2 years of follow-up, recurrence occurred in 4 patients in group A and 2 patients in group B. The ODI score and JOA score in group A and B were 18%±9%, 24.2±1.3 and 16%±7%, 23.9±1.3, respectively. There were not significantly different between patients in group A and B (t=1.70, P=0.090; t=1.71, P=0.088). The VAS score of lumbar pain of patients in group A was better than that of patients in group B (P<0.05). Conclusion Most of PETD of L3-S1 segments can reach the therapeutic target without performing foraminoplasty with half-half technique combined with far lateral access technique. Due to the special anatomical position of L5-S1 segment, the probability of performing foraminoplasty during operation is much higher. Performing foraminoplasty or not depends on the preoperative measurement of foramina and verification during the operation. Key words: Lumbar vertebrae; Intervertebral disc displacement; Diskectomy, percutaneous; Foraminotomy

Application progress of percutaneous transforaminal endoscopic discectomy in the treatment of lumbar intervertebral disc herniation

Lumbar intervertebral disc herniation (LDH) is a syndrome caused by various reasons such as nucleus pulposus protrusion, compression of nerve root and herniation of nucleus pulposus, and stimulation of nerve root and cauda equina nerve. It is one of the most common diseases in orthopedics. There are a variety of surgical treatments for this disease, including traditional open surgery and minimally invasive techniques. At present, the minimally invasive technique represented by percutaneous transforaminal endoscopy has gradually replaced the traditional open surgery as the mainstream because of its advantages of less trauma, faster recovery and fewer complications. This article will systematically expound the application and progress of percutaneous lumbar intervertebral foraminoscopy in the treatment of lumbar disc herniation from the development course, indications, operation skills, matters needing attention, curative effect analysis, complications and so on. Key words: Lumbar vertebrae/SU; Intervertebral disk displacement/SU; Diskectomy, percutaneous; Endoscopy; Review

Clinical report of revision surgery after percutaneous transforaminal endoscopic surgery for lumbar stenosis

Objective To analyze the causes of revision surgery after percutaneous transforaminal endoscopic discectomy (PTED) for lumbar spinal stenosis, and to provide references for indications and operative methods. Methods From January 2015 to October 2017, 206, 491 and 60 patients of lumbar spinal stenosis were treated with PTED in Tianjin Hospital, Shanxi People's Hospital, Ningbo Sixth Hospital, respectively; among them, 4, 10 and 4 cases received revision surgery. Another 13 patients of lumbar spinal stenosis were treated with revision surgery due to poor results after PTED in other hospitals. Among 31 cases of reoperation, there were 16 males and 15 females, aged 27-82 years (average, 66.2±12.7 years). The lesion segments included 1 case of L3,4, 23 cases of L4,5, 5 cases of L 5S1, 1 cases of L 3-L5, and 1 cases of L 4-S1. Patients were followed up after reoperation from 3 to 24 months (average, 12.1 months). The causes of poor result and revision surgery were analyzed according to preoperative, intra-operative and postoperative data. Results All of 757 cases of lumbar spinal stenosis were treated with PTED in three hospitals, of which 18 cases (2.4%) were re-operated. The causes of reoperation included: bone slice displacement in 1 case; nerve injury in 4 cases; lumbar instability in 4 cases; disc protrusion in 10 cases (residual or recurrence); insufficient decompression in 21 cases; planed staging operation in 4 cases with bilateral or two-level stenosis. 32 revision surgeries were performed for 31 patients, including PTED in 15 cases, microendoscopic discectomy (MED) in 1 case, mobile MED (MMED) in 5 cases, MMED assisted fusion in 2 cases, transforaminal lumbar interbody fusion (TLIF) in 4 cases, Minimally invasive TLIF (Mis-TLIF) in 2 cases, and open decompression and fusion in 3 cases. All patients experienced relieve of symptoms after revision surgery. At final follow-up, VAS leg pain deceased form 7.1±3.9 before revision surgeries to 1.9±1.2, VAS low back pain decreased form 6.3±3.2 to 1.8±1.3, ODI score decreased from 35%±14% to 7.6%±5%. According to the MacNab score, the result was excellent in 11 cases, good in 16 cases, and fair in 4 cases. Conclusion The treatment of lumbar stenosis with PTED has high technical requirements, the indications of PTED for lumbar stenosis should be strictly controlled according to technical conditions, and appropriate operative methods should be chosen according to the specific conditions of the lesions. Insufficient decompression, disc protrusion, lumbar instability and nerve injury are the common causes of reoperation. Suitable indications and proper operation should be selected. Key words: Lumbar vertebrae; stenosis; Endoscopy; Surgical procedures; Outcome

Effects of handholding and providing information on physiology and psychology in patients undergoing percutaneous transforaminal endoscopic discectomy under local anesthesia

Objective To evaluate the effects of handholding and providing information on physiology and psychology in patients undergoing percutaneous transforaminal endoscopic discectomy under local anesthesia. Methods A total of 74 patients receiving percutaneous transforaminal endoscopic discectomy under local anesthesia in China-Japan Friendship Hospital in Beijing were selected and randomly divided into the intervention group and the control group by random number table, with 60 cases in each. During surgery, the patients in the control group only received routine cares, in the intervention group, except the routine cares, nurses held the hands of patients for 20-30 seconds every 10 minnutes and provided them with spoken information. Then the State-Anxiety Inventory (SAI) scale and Visual Analogue Scale (VAS) were used for assessment of anxiety and pain of two groups of patients. Results The results showed that there was no statistically significant difference in SAI score between both groups the day before surgery and before surgery in operation room (P>0.05). The SAI scores of the control group (42.30±10.14) was lower than that of the intervention group (35.35±8.00), there was statistically significant difference between both groups (t=3.273, P=0.002); the VAS score in the control group (54.16±22.02) was lower than that of the intervention group (41.68±15.30), there was statistically significant difference between both groups (t=2.832, P=0.006). Conclusions The nursing method of handholding and providing information for patients who undergoing percutaneous transforaminal endoscopic discectomy under local anesthesia is very useful intervention, it can mitigate surgical anxiety, pain degree. It makes patients more comfortable whether in physiology or psychology and better fit surgery. Key words: Discectomy; Endoscopy; Therapeutic touch; Information; Anxiety; Pain

Percutaneous transforaminal endoscopic bilateral decompression via unilateral approach for lumbar spinal stenosis caused by lumbar disc herniation

Objective To evaluate the clinical results of percutaneous transforaminal endoscopic bilateral decompression (PTED)via unilateral approach for lumbar spinal stenosis (LSSS) caused by lumbar disc herniation (LDH). Methods From January 2014 to January 2016, 35 cases of LSS caused by LDH were treated with PTED via unilateral approach at Affiliated Hospital of Logistics University of Chinese Armed Police Force, and their data were used for a retrospective analysis. The surgical effect was evaluated using the Macnab score at 3 months post-operation. Visual analogue scale (VAS) and Oswestry disability index(ODI)were used to assess the outcomes at 6 month post-operation.MxLiteView DICOM Viewer software was used to measure the change of spinal canal area before and after operation based on the parameters of axial MRI images. Results The mean operation time was (89.1±8.7) min in 35 patients.The preoperative and 6-month postoperative VAS values were (7.9±0.8) and (2.1±0.5) points, respectively, and the ODI were(61.5±3.7) and(21.3±2.1)points, respectively. Both differences were statistically significant (P<0.05). As per the Macnab criteria, 19 patients (54.4%) reported excellent effect, 13 (37.1%) demonstrated good outcome, 2 (5.7%) reported faireffect, and 1 (2.9%) demonstrated poor result.The excellent/good rate reached 91.4%. Compared with the preoperative conditions, the cross sectional areas of spinal canal at the levels of L3-4, L4-5 and L5-S1were increasedby (35.7±8.5) mm2, (40.9±4.1) mm2 and (42.5±9.1) mm2, respectively.No postoperative rupture of spinal dura, or injury of nerves, blood vesselsas well as intestines, or infection occurred in this series. The most frequently observed complication was transient paresthesia due to irritation of nerve root. Conclusions The procesure of PTED via unilateral approach demonstrate satisfactory short-term effect in the treatment of LSS caused by LDH. Further long-term observations are needed to investigate postoperative stability of lumbar spinal canal, the risk of restenosis, and possibility of re-operation in case of restenosis. Key words: Spinal stenosis; Lumbar vertebrae; Decompression, surgical; Percutaneous transforaminal endoscopic discectomy; Bilateral decompression via unilateral approach

A comparison of the transforaminal versus the interlaminar approach to percutaneous endoscopic surgeries in treating lumbar disc herniation

Objective To evaluate the indications and clinical results of percutaneous transforaminal endoscopic discectomy (PTED) and percutaneous interlaminar endoscopic discectomy (PIED) for the treatment of lumbar disc herniation (LDH). Methods A total of 126 patients of LDH were retrospectively analyzed, who were admitted to Department of Neurosurgery, Beijing Hospital and Department of Neurosurgery, Xuanwu Hospital, Capital Medical University from April 2014 to June 2015. According to the surgical approach, the patients were divided into the PTED (66 cases) and PIED (60 cases) groups.Pre- and postoperative pain was assessed using the visual analog scale (VAS) and the patient’s functional status was evaluated using the Oswestry disability index (ODI). Various aspects were compared between the two groups that included operation time, times of intraoperative radioactive examinations, length of hospital stay, complications and postoperative recovery.The follow-up time is 3 to 23 months. Results In both groups, the patients' mean VAS scores and ODI were significantly decreased compared with data before operation(all P 0.05). The operation time(85.6±19.0 min) and frequencies of radiation exposure (28.1±10.3) in the PTED group were significantly higher than in the PIED group(operation time: 59.6±13.0 min, frequency of radiation exposure: 4.9±1.5); while the postoperative bedridden time(4.6±0.9 h) and complication rate (4.5%) in the PTED group were significantly lower than in the PIED group (bedridden time: 9.9±3.7 h, complication rate: 13.3%). Conclusions PTED and PIED are generally safe and efficacious in treatment of LDH.Selection of surgical approaches should be based on LDH types and locations. Key words: Intervertebral disc degeneration; Lumbar vertebrae; Diskectomy, percutaneous; Transforaminal; Interlaminar

The therapeutic effect of percutaneous transforaminal endoscopic discectomy through interlaminar approach for treating lumbar disc herniation

Objective To evaluate the therapeutic efficacy of percutaneous transforaminal endoscopic discectomy (PTED) through interlaminar approach in the treatment of lumbar disc herniation (LDH). Methods From October 2013 to January 2015, 54 LDH patients underwent PTED by using transforaminal endoscopic spine system (TESSYS) in our hospitial. CT or MRI indicated L 4-5 disc herniation in 13 patients and L 5 -S 1 disc herniation in other 41 patients. Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the degree of pain in the low back and leg before operation, one day, 3 months and one year after operation. MRI was performed after operation to assess if the nucleus pulposus was removed completely and whether there was a relapse. Results The success rate of operations was 96.30% (52/54). Two patients suffered from rupture of spinal dura mater during the surgery, and underwent fenestration laminectomy in turn. The average operation time was 58.35 min and median hospital stay was 3 d. At discharge, pain was disappeared in 52 patients and relieved in 2 patients, however, 5 patients presented worsened numbness of lateral lower leg. Compared with preoperation, VAS and ODI scores decreased significantly one day, 3 months and one year after operation ( P = 0.000, for all). Lumbar MRI one day after operation revealed nucleus pulposus had been completely removed and the compression of nerve root had been relieved in all cases. There was no relapse in MRI findings 3 months and one year after operation. No surgical complication, such as infection, was found. One patient with L 5 -S 1 disc herniation presented postoperative numbness of S 1 nerve root region caused by heavy stretching of nerve root during the operation, and was improved one month later. Conclusions Percutaneous transforaminal endoscopic discectomy through interlaminar approach in the treatment of lumbar disc herniation is effective and safe. DOI: 10.3969/j.issn.1672-6731.2016.04.006

Analysis and treatment of surgical complications after percutaneous transforaminal endoscopic discectomy for treating lumbar disc herniation and lumbar intervertebral foraminal stenosis

Objective To analyze the causes of surgical complications after treatment of lumbar disc herniation (LDH) and lumbar intervertebral foraminal stenosis by percutaneous transforaminal endoscopic discectomy (PTED). Methods From December 2009 to December 2014, 286 patients with LDH (N = 201) and lumbar intervertebral foraminal stenosis (N = 85) were confirmed by X-ray, CT or MRI and treated by PTED in our hospital. Visual Analogue Scale (VAS) was used to evaluate the degree of pain in each paitent before and after operation. The curative effect was evaluated by Macnab score. Surgical complications were recorded to find out the causes and methods to prevent them. Results All cases were followed up for 3 months, and the VAS score decreased significantly compared with preoperation [1.00 (0.00, 1.05) vs 8.50 (7.75, 9.25); Z = 2.825, P = 0.050]. According to Macnab score, the rate of excellent and good functional recovery was 95.45% (273/286). Procedure-related complications included nerve injury in 8 cases (2.80%), hemorrhage at the operation site and hematoma formation around nerve root in 6 cases (2.10%), rupture of dural sac in one case (0.35%), muscle cramps in 3 cases (1.05%), surgical infection in one case (0.35%), postoperative recurrence in 4 cases (1.40%). All patients with complications were cured after symptomatic treatment. Conclusions The overall effect of percutaneous transforaminal endoscopic discectomy for treating lumbar disc herniation and lumbar intervertebral foraminal stenosis is satisfactory, which has a low incidence rate of postoperative complications. Some tips can effectively reduce the rate of surgical complications such as preoperative evaluation, precise performance, careful hemostasis, shortening the operation time and postoperatively symptomatic treatment, etc. DOI: 10.3969/j.issn.1672-6731.2016.04.007

Percutaneous transforaminal endoscopic discectomy combined with radiofrequency annuloplasty for treatment of lumbar disc herniation

AbstractBACKGROUND:Percutaneous transforaminal endoscopic discectomy combined with radiofrequency annuloplasty is a minimally invasive therapy for chronic discogenic low back pain, especially suitable for lumbar disc herniation.OBJECTIVE:To evaluate the safety and short-term efficacy of percutaneous

Technique skill and clinical choices of the YESS and TESSYS in percutaneous transforaminal endoscopic discectomy for lumbar disc herniations.

Objective To describe the techniques skill, indictions and clinical effects of the Yeung endoscopic spine system (YESS) and transforaminal endoscopic spine system (TESSYS) percutaneous transforaminal endoscopic techniques for lumbar disc herniations. Methods From September 2005 to May 2008, 201 patients with lumbar disc hemiations were treated with posterolateral endoscopic discectomy techniques. There were two techniques had been used in this group: 150 cases with YESS and 51 with TESSYS. There were 122 males and 79 females, with an average age of 33.5 years. Results The follow-up period was 12.5 months (range 3 to 36 months). 119 patients (follow-up rate was 79.3%) had been followed-up in YESS operative group, while 43 patients (follow-up rate was 84.3%) in TESSYS operative group. Pain was measured by means of the Visual Analogue Score (VAS), the patient satisfaction was evaluated by the Nakai outcome criteria. Mean VAS of YESS group was improved from 8.4±2.1 before the surgery to 2.4±0.8 one year after the surgery, while TESSYS group from 8.6±2.3 betore the surgery to 2.6±1.3 one year after the surgery. There scores all increased significantly compared with their preoperative ones. Overall, excellent or good outcomes were obtained in 87.5% of the YESS group and in 88.4% of the TESSYS group. No persistent nerve root injuries and dural tear were happened. Eight patients were unsatisfactory in YESS group and 3 in TESSYS group. Four patients (3.4%) were experienced persistent radiculopathy in YESS group, but only one (2.3%) happened radiculopathy in TESSYS group. Four recurrent cases (recurrent rate 3.4%) in YESS group and two recurrent patients (recurrent rate 4.7%) in TESSYS group had been underwent microendoscopic revision surgery. Conclusion Transforaminal percutaneous endoscopic discectomy is safe and effieacious in the treatment of lumbar disc herniations. However, proper selection for YESS and TESSYS techniques is important to ensure the successful and satisfactory outcome for the lumbar disc herniations. Key words: Intervertebral disk displacement; Endoseopes; Lumbar vertebrae