Article
Transforaminal lumbar sequestrectomy: Where do we stand 3 years after implementation of the technique in a university hospital setting?
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Authors
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Michael Bender
- Department of Neurosurgery, Justus-Liebig-University Giessen, Giessen, Deutschland
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Lukas Herrmann
- Department of Neurosurgery, Justus-Liebig-University Giessen, Giessen, Deutschland
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Carolin Gramsch
- Department of Neuroradiology, Justus-Liebig-University Giessen, Giessen, Deutschland
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Eberhard Uhl
- Department of Neurosurgery, Justus-Liebig-University Giessen, Giessen, Deutschland
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Karsten Schoeller
- Department of Neurosurgery, Justus-Liebig-University Giessen, Giessen, Deutschland
| Published: | June 9, 2017 |
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Outline
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Objective: Microsurgical discectomy/sequestrectomy is the standard procedure for the surgical treatment of lumbar disc herniations. The transforaminal endoscopic sequestrectomy technique with the TESSYS system is a minimally invasive alternative with potential advantages like minimal blood loss and tissue damage, as well as early mobilization of the patient. We report our experiences from the first 3 years after implementation of the technique in a university hospital setting.
Methods: From February 2013 to July 2016 we used TESSYS for lumbar sequestrectomy in 44 patients. A retrospective analysis was conducted in 33 patients, 11 additional patients were included in a prospective manner. Demographic as well as perioperative clinical and radiological data were extracted from electronic records. Intraoperative change of the procedure to microsurgery, complications, and reoperations were meticulously investigated. Analysis of the postoperative course using the Macnab criteria was supplemented by a questionnaire (last follow-up, LFU). Pre- and postoperative magnetic resonance imaging (MRI) volumetry was carried out in the prospective cohort to assess radiological efficacy of the technique.
Results: The median age of our total cohort was 53 years, and the median follow-up was 19 months. The median length of hospital stay was 5 days. Duration of surgery (median) was 102 minutes (no significant change during the course of the study) with a median blood loss of 50 ml. Surgery was most commonly performed at the level L 4/5 (63% of total cohort) and in caudally migrated disc herniations (46% of total cohort); in 6 patients surgery was performed for recurrent disc herniations. The procedure had to be changed to conventional microsurgery in 4 patients. There were no major complications. Minor complications occurred in 5 patients; in 4 patients a reoperation had to be carried out. At discharge and at LFU 84% and 78% of the patients had an excellent or good clinical outcome according to the Macnab criteria, respectively. In the MRI volumetry we detected a median postoperative volume reduction of the disc herniation of 57%.
Conclusion: The TESSYS technique can be safely established in a university hospital setting in selected patients with primary and recurrent lumbar disc herniations. The learning curve is flat, however, the first clinical and radiological results are promising. Potential advantages are low blood loss and short length of hospital stay.
