Yong Zhang1, Zhimin Pan2, Yanghong Yu3, Daying Zhang1, Yoon Ha2, Seong Yi2, Dong Ah Shin2, Jingyi Sun4, Hisashi Koga5, Kevin Phan6, Parisa Azimi7, Wei Huang8, Kai Cao9. 1. Pain Department, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China. 2. Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea. 3. Department of Radiology, Jiangxi Province Children's Hospital, Nanchang 330006, China. 4. Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Gangwon 220-701, Republic of Korea. 5. Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan. 6. NeuroSpine Surgery Research Group (NSURG); Prince of Wales Clinical School, University of New South Wales, Randwick, Sydney, Australia. 7. Functional Neurosurgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 8. Department of Clinical Laboratory, Jiangxi Province Children's Hospital, Nanchang 330006, China. 9. Department of Orthopedics, the Second Affiliated Hospital of Nanchang University, Nanchang 330006, China.
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.
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.