Transforaminal endoscopic spinal surgery: the future 'gold standard' for discectomy? - A review.
BACKGROUND
Lumbar disc prolapse is common and the primary method of care in most centres is still open discectomy facilitated by microscope or loupe magnification and illumination. Hospitalisation may be less than 24 h, but post-operative pain usually requires an overnight stay. This review describes transforaminal endoscopic spinal surgery (TESS) using HD-video technology, that is generally performed as a day case procedure under sedation or light general anaesthesia, and collates the evidence comparing the technique to microdiscectomy.


METHODS
The method of TESS is described and an electronic literature search performed to identify papers reporting clinical outcomes. International data were translated where necessary and proceedings' abstracts included. In addition, papers held by the authors and colleagues in personal libraries were carefully cross-referenced to the obtained database.


RESULTS
Analysis of the data supports the use of a transforaminal endoscopic approach to the lumbar intervertebral disc and suggests that outcomes following surgery are at least equivalent to those following microdiscectomy. Significant cost-savings in terms of in-patient stay may be generated. In addition, there is also some evidence supporting endoscopic surgery for relief of foraminal stenosis.


CONCLUSIONS
Based on current evidence there are good arguments supporting a more wide-spread adoption of transforaminal endoscopic surgery for the treatment of lumbar disc prolapse with or without foraminal stenosis.
Department of Orthopaedic Surgery, The Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SU, United Kingdom. j.n.a.gibson@blueyonder.co.uk
J N Alastair
JN
Gibson
Jonathan G
JG
Cowie
Menno
M
Iprenburg
D017046:Cost Savings; D017586:Diskectomy / Q000191:economics / Q000379:methods*; D004724:Endoscopy / Q000191:economics / Q000379:methods*; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000191:economics / Q000601:surgery*; D059032:Learning Curve; D008159:Lumbar Vertebrae; D009873:Operating Rooms; D017060:Patient Satisfaction; D062707:Return to Work / Q000706:statistics & numerical data; D016896:Treatment Outcome