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J Neurol Surg A Cent Eur Neurosurg 2018; 79(04): 285-290
DOI: 10.1055/s-0038-1639503
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Outcome Predictors of the Transforaminal Endoscopic Spine System Technique for Single-level Lumbar Disk Herniation

Jinchun Wu
1   Department of Orthopedics, Jingjiang People's Hospital, Jingjiang, China
,
Bin Yu
2   Department of Spine Surgery, Shanghai East Hospital, Shanghai, China
,
Bin He
1   Department of Orthopedics, Jingjiang People's Hospital, Jingjiang, China
,
Gang Liu
1   Department of Orthopedics, Jingjiang People's Hospital, Jingjiang, China
,
Jidong Ju
1   Department of Orthopedics, Jingjiang People's Hospital, Jingjiang, China
,
Jianguang Zhu
2   Department of Spine Surgery, Shanghai East Hospital, Shanghai, China
› Author Affiliations
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Publication History

18 April 2017

09 November 2017

Publication Date:
12 April 2018 (online)

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Abstract

Background Endoscopic spine surgery has become increasingly popular. However, no study has researched the predictive factors for different outcomes. This study is the first to evaluate the outcome predictors of the transforaminal endoscopic spine system (TESSYS) technique for lumbar disk herniation (LDH).

Methods We performed a prospective study of 80 patients meeting the inclusion criteria who underwent TESSYS for LDH. Clinical outcomes were assessed by the visual analog scale (VAS), the Oswestry Disability Index (ODI), and the modified MacNab criteria. Univariate and multivariate analyses were performed to evaluate the outcome predictors.

Results There were 36 men and 44 women with a mean age of 48.76 ± 15.60 years (range: 24–78 years). The mean follow-up time was 25.15 ± 9.76 months (range: 12–48 months). The VAS and ODI scores at the last follow-up were significantly improved (p < 0.001). Based on the modified MacNab criteria, the global outcomes were excellent in 34 patients (42.5%), good in 26 patients (32.5%), fair in 11 patients (13.75%), and poor in 9 patients (11.25%). The percentage of symptomatic improvement was 88.75%, and the success rate (excellent or good) was 75%. In the univariate and multivariate analyses, LDH with older age (odds ratio [OR]: 6.621; 95% confidence interval [CI], 0.632–20.846; p = 0.019), high-intensity zone (HIZ) (OR: 8.152; 95% CI, 0.827–4.380; p = 0.003), and larger disk herniation (OR: 6.819; 95% CI, 0.113–4.825; p = 0.017) were the most significant negative outcome predictors.

Conclusions TESSYS is an effective method to treat LDH. Older age, the existence of an HIZ, and a large disk herniation were the most important predictors for a worse outcome.

Keywords

lumbar disk herniation - transforaminal endoscopic spine surgery - risk factor
 

  • References

  • 1 Andersson GB. Epidemiological features of chronic low-back pain. Lancet 1999; 354 (9178): 581-585
    CrossrefPubMedSearch in Google Scholar
  • 2 Xin G, Shi-Sheng H, Hai-Long Z. Morphometric analysis of the YESS and TESSYS techniques of percutaneous transforaminal endoscopic lumbar discectomy. Clin Anat 2013; 26 (06) 728-734
    CrossrefPubMedSearch in Google Scholar
  • 3 Du J, Tang X, Jing X, Li N, Wang Y, Zhang X. Outcomes of percutaneous endoscopic lumbar discectomy via a translaminar approach, especially for soft, highly down-migrated lumbar disc herniation. Int Orthop 2016; 40 (06) 1247-1252
    CrossrefPubMedSearch in Google Scholar
  • 4 Zonana-Nacach A, Moreno-Cazares MC, Gómez-Naranjo R. Financial expenses incurred by herniated disk in health professionals [in Spanish]. Cir Cir 2013; 81 (05) 400-404
    PubMedSearch in Google Scholar
  • 5 Asch HL, Lewis PJ, Moreland DB. , et al. Prospective multiple outcomes study of outpatient lumbar microdiscectomy: should 75 to 80% success rates be the norm?. J Neurosurg 2002; 96 (1, Suppl): 34-44
    Search in Google Scholar
  • 6 Kambin P, Brager MD. Percutaneous posterolateral discectomy. Anatomy and mechanism. Clin Orthop Relat Res 1987; (223) 145-154
    PubMedSearch in Google Scholar
  • 7 Hoogland T, Schubert M, Miklitz B, Ramirez A. Transforaminal posterolateral endoscopic discectomy with or without the combination of a low-dose chymopapain: a prospective randomized study in 280 consecutive cases. Spine 2006; 31 (24) E890-E897
    CrossrefPubMedSearch in Google Scholar
  • 8 Tsou PM, Alan Yeung C, Yeung AT. Posterolateral transforaminal selective endoscopic discectomy and thermal annuloplasty for chronic lumbar discogenic pain: a minimal access visualized intradiscal surgical procedure. Spine J 2004; 4 (05) 564-573
    CrossrefPubMedSearch in Google Scholar
  • 9 Pan Z, Ha Y, Yi S, Cao K. Efficacy of transforaminal endoscopic spine system (TESSYS) technique in treating lumbar disc herniation. Med Sci Monit 2016; 22: 530-539
    CrossrefPubMedSearch in Google Scholar
  • 10 Ogon M, Krismer M, Söllner W, Kantner-Rumplmair W, Lampe A. Chronic low back pain measurement with visual analogue scales in different settings. Pain 1996; 64 (03) 425-428
    CrossrefPubMedSearch in Google Scholar
  • 11 Davidson M, Keating JL. A comparison of five low back disability questionnaires: reliability and responsiveness. Phys Ther 2002; 82 (01) 8-24
    CrossrefPubMedSearch in Google Scholar
  • 12 Ahn Y, Lee SH. Outcome predictors of percutaneous endoscopic lumbar discectomy and thermal annuloplasty for discogenic low back pain. Acta Neurochir (Wien) 2010; 152 (10) 1695-1702
    CrossrefPubMedSearch in Google Scholar
  • 13 Aprill C, Bogduk N. High-intensity zone: a diagnostic sign of painful lumbar disc on magnetic resonance imaging. Br J Radiol 1992; 65 (773) 361-369
    CrossrefPubMedSearch in Google Scholar
  • 14 Akhaddar A, Belfquih H, Salami M, Boucetta M. Surgical management of giant lumbar disc herniation: analysis of 154 patients over a decade. Neurochirurgie 2014; 60 (05) 244-248
    CrossrefPubMedSearch in Google Scholar
  • 15 Jeon CH, Chung NS, Son KH, Lee HS. Massive lumbar disc herniation with complete dural sac stenosis. Indian J Orthop 2013; 47 (03) 244-249
    CrossrefPubMedSearch in Google Scholar
  • 16 Choi KC, Kim JS, Park CK. Percutaneous endoscopic lumbar discectomy as an alternative to open lumbar microdiscectomy for large lumbar disc herniation. Pain Physician 2016; 19 (02) E291-E300
    Search in Google Scholar
  • 17 Telfeian AE. Transforaminal endoscopic solution to disk reherniation post-mini-TLIF: case report. Clin Neurol Neurosurg 2015; 131: 69-71
    CrossrefPubMedSearch in Google Scholar
  • 18 Yao H, Xu YC, Chen BY, Hou G, Zhao HQ. Surgical revision of lumbar vertebrae using transforaminal endoscopic spine system [in Chinese]. Zhongguo Gu Shang 2015; 28 (08) 712-716
    PubMedSearch in Google Scholar
  • 19 Jasper GP, Francisco GM, Telfeian AE. Clinical success of transforaminal endoscopic discectomy with foraminotomy: a retrospective evaluation. Clin Neurol Neurosurg 2013; 115 (10) 1961-1965
    CrossrefPubMedSearch in Google Scholar
  • 20 Heifertz MD. Lumbar disc herniation: microsurgical approach. Neurosurgery 2003; 53 (01) 248 ; author reply 248
    CrossrefPubMedSearch in Google Scholar
  • 21 Nie H, Zeng J, Song Y. , et al. Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation via an interlaminar approach versus a transforaminal approach: a prospective randomized controlled study with 2-year follow up. Spine 2016; 41 (Suppl. 19) B30-B37
    CrossrefPubMedSearch in Google Scholar
  • 22 Cheng J, Zheng W, Wang H. , et al. Posterolateral transforaminal selective endoscopic diskectomy with thermal annuloplasty for discogenic low back pain: a prospective observational study. Spine (Phila Pa 1976) 2014; 39 (26 Spec No.): B60-B65
    PubMedSearch in Google Scholar
  • 23 Sinkemani A, Hong X, Gao ZX. , et al. Outcomes of microendoscopic discectomy and percutaneous transforaminal endoscopic discectomy for the treatment of lumbar disc herniation: a comparative retrospective study. Asian Spine J 2015; 9 (06) 833-840
    CrossrefPubMedSearch in Google Scholar
  • 24 Kim YS, Chin DK, Yoon DH, Jin BH, Cho YE. Predictors of successful outcome for lumbar chemonucleolysis: analysis of 3000 cases during the past 14 years. Neurosurgery 2002; 51 (5, Suppl): S123-S128
    PubMedSearch in Google Scholar
  • 25 Klemencsics I, Lazary A, Szoverfi Z, Bozsodi A, Eltes P, Varga PP. Risk factors for surgical site infection in elective routine degenerative lumbar surgeries. Spine J 2016; 16 (11) 1377-1383
    CrossrefPubMedSearch in Google Scholar
  • 26 Sanchez-Mariscal F, Gomez-Rice A, Rodriguez-Lopez T. , et al. Preoperative and postoperative sagittal plane analysis in adult idiopathic scoliosis in patients older than 40 years of age. Spine J 2017; 17 (01) 56-61
    CrossrefPubMedSearch in Google Scholar
  • 27 Park JH, Li G, Kim M. Incidence and risk factors of postoperative hematoma requiring reoperation in single level lumbar fusion surgery. Spine 2017; 42 (06) 428-436
    CrossrefPubMedSearch in Google Scholar
  • 28 Hermann PC, Webler M, Bornemann R. , et al. Influence of smoking on spinal fusion after spondylodesis surgery: a comparative clinical study. Technol Health Care 2016; 24 (05) 737-744
    PubMedSearch in Google Scholar
  • 29 Stienen MN, Joswig H, Smoll NR. , et al. Short- and long-term effects of smoking on pain and health-related quality of life after non-instrumented lumbar spine surgery. Clin Neurol Neurosurg 2016; 142: 87-92
    CrossrefPubMedSearch in Google Scholar
  • 30 Bydon M, De la Garza-Ramos R, Abt NB. , et al. Impact of smoking on complication and pseudarthrosis rates after single- and 2-level posterolateral fusion of the lumbar spine. Spine 2014; 39 (21) 1765-1770
    CrossrefPubMedSearch in Google Scholar
  • 31 Burke JG, Watson RW, McCormack D, Dowling FE, Walsh MG, Fitzpatrick JM. Intervertebral discs which cause low back pain secrete high levels of proinflammatory mediators. J Bone Joint Surg Br 2002; 84 (02) 196-201
    Search in Google Scholar