Percutaneous transforaminal endoscopic surgery (PTES) for symptomatic lumbar disc herniation: a surgical technique, outcome, and complications in 209 consecutive cases.
BACKGROUND
We 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.


METHODS
PTES 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.


RESULTS
The 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.


CONCLUSIONS
PTES 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.
Department of Orthopaedics, Zhongshan Hospital of Fudan University, Shanghai, 200032, China. 447574313@qq.com.
Yu-Tong
YT
Gu
Department of Orthopaedics, Zhenjiang Hospital of Traditional Chinese and Western Medicine, Zhenjiang, Jiangsu, 212005, China.
Zhan
Z
Cui
Department of Orthopaedics, Taizhou Hospital of Traditional Chinese and Western Medicine, Taizhou, Jiangsu, 225300, China.
Hong-Wei
HW
Shao
Department of Orthopaedics, Zhenjiang Hospital of Traditional Chinese and Western Medicine, Zhenjiang, Jiangsu, 212005, China. yizi1001@163.com.
Yun
Y
Ye
Department of Orthopaedics, Taizhou Hospital of Traditional Chinese and Western Medicine, Taizhou, Jiangsu, 225300, China.
Ai-Qun
AQ
Gu
D000328:Adult; D000368:Aged; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods; D017587:Diskectomy, Percutaneous / Q000009:adverse effects / Q000379:methods*; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D011843:Radiculopathy / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D064232:Visual Analog Scale
Endoscopic discectomy; Lumbar disc herniation; Minimally invasive surgery; Transforaminal