Objective To evaluate the effectiveness of visualized reamer foraminoplasty in transforaminal endoscopic lumbar discectomy (TELD) for the treatment of lumbar disc herniation (LDH). Methods A retrospective analysis was conducted on the clinical data of 100 LDH patients who met the selection criteria and underwent TELD between January 2022 and June 2024. According to the foraminoplasty technique, patients were divided into a visualized group and a transforaminal endoscopic spine system (TESSYS) group, with 50 patients in each group. There were no significant differences in baseline data between the two groups (P>0.05), including gender, age, surgical level, disease duration, preoperative visual analogue scale (VAS) scores for low back and lower limb pain, and Oswestry disability index (ODI). The intraoperative fluoroscopy frequency, operation time, intraoperative blood loss, hospital stay, time from operation to discharge, and complications were recorded and compared between the two groups. Low back and lower limb pain were assessed using VAS scores, and function status was evaluated using ODI preoperatively and at 1 day, 1, 3, 6, and 12 months postoperatively. Surgical outcomes were evaluated at last follow-up using the modified MacNab criteria. Results All surgeries were completed successfully, with primary healing of the incisions. The visualized group showed significantly shorter operation time and fewer fluoroscopy frequencies than the TESSYS group (P<0.05). No significant differences were found between the two groups in intraoperative blood loss, time from operation to discharge, or hospital stay (P>0.05). One case of recurrence occurred in the visualized group, compared to 3 cases in the TESSYS group, with no significant difference between the groups (P>0.05). Postoperative lower limb dysesthesia occurred in 4 cases in the TESSYS group, but was not observed in the visualized group, showing a significant difference (P<0.05). No other complications, such as vascular injury, cerebrospinal fluid leakage, incisional hematoma, or infection occurred in either group. Both groups showed significant improvement in low back VAS score, lower limb VAS score, and ODI at all postoperative time points compared to preoperative values (P<0.05). No significant difference was found in low back VAS score, lower limb VAS score, or ODI between the two groups at any postoperative time point (P>0.05). According to the modified MacNab criteria at last follow-up, the excellent-good rates were 96% and 92% in the visualized and TESSYS groups, respectively, with no significant difference (P>0.05). Conclusion Both TESSYS and visualized reamer foraminoplasty techniques yield satisfactory outcomes in the treatment of LDH via TELD. The latter can significantly reduce intraoperative fluoroscopy frequency and operation time, but the effectiveness of the two groups is comparable.
Objective To analyze the medium and long-term effectiveness of microendoscope-assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for lumbar degenerative diseases in comparison with conventional tubular retractor-assisted MIS-TLIF. Methods Between November 2008 and March 2013, 53 patients with single segment lumbar degenerative diseases were enrolled. According to the different working channel performed, 28 patients were treated by microendoscope-assisted MIS-TLIF (observation group), while the remaining cases received conventional tubular retractor-assisted MIS-TLIF via Wiltse approach (control group). Preoperative baseline data, including age, gender, body mass index, disease etiology, operated level, the ration for requiring bilateral canal decompression, and preoperative visual analogue scale (VAS) socre of low back pain and leg pain, Japanese Orthopedic Association (JOA) score, Oswestry disability index (ODI) score, showed no significant difference between the two groups (P>0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy time, postoperative analgesic drug dose, postoperation in-bed time, and perioperative complication incidence were recorded respectively and compared between the two groups. Radiographic evaluation of interbody fusion was performed based on Bridwell grading system at 2 years after operation. VAS scores of low back pain and leg pain, JOA score, and ODI score were assessed before operation, at 2 years after operation, and at last follow-up respectively. Surgical outcome satisfaction was assessed by modified MacNab criteria at last follow-up. Results When compared with those in control group, both intraoperative blood loss and postoperative analgesic drug dose were significantly decreased in observation group (P<0.05); similarly, the operation time and intraoperative fluoroscopy time were also significantly increased in observation group (P<0.05). There was no significant difference of postoperative in-bed time between the two groups (t=–0.812, P=0.420). Both groups were followed up 6-10.3 years, with an average of 7.9 years. Regarding perioperative complication, its incidence was 14.3% and 20.0% in observation group and control group, respectively, showing no significant difference between both groups (χ2=0.306, P=0.580). Specifically, there were intraspinal hematoma formation in 1 case, incision infection in 1 case, urinary infection in 1 case, transient delirium in 1 case in observation group. By contrast, there were dural tear and cerebrospinal fluid leakage in 1 case, urinary infection in 1 case, pneumonia in 1 case, transient delirium in 2 cases in control group. Bridwell criterion was used to judge the intervertebral fusion at 2 years after operation, the fusion rates of observation group and control group were 92.9% and 92.0%, respectively, showing no significant difference (χ2=0.162, P=0.687). At both 2-year postoperatively and last follow-up, the VAS scores of low back pain and leg pain, JOA score, and ODI score were significantly improved when compared with those before operation (P<0.01), whereas no significant difference between the two groups at either time point was found (P>0.05). At last follow-up, the results of patients’ satisfaction with surgery evaluated by modified MacNab criteria, and the excellent and good rates of the observation group and the control group were 96.4% and 92.0%, respectively, showing no significant difference (χ2=0.485, P=0.486). Conclusion The medium and long-term effectiveness of microendoscope-assisted MIS-TLIF are similar to those of conventional tubular retractor-assisted MIS-TLIF for lumbar degenerative diseases. The former operation has the additional advantages in terms of more clear surgical site visually, less intraoperative blood loss, and reduced postoperative analgesic dose, all of which seem more feasible to clinical teaching.