Short-term Efficacy Of Percutaneous Transforaminal TESSYS In The Treatment Of Lumbar Disc Herniation

Objective: To study the preoperative and postoperative evaluation indexes of patients with LDH by TESSYS technique and traditional fenestration operation,and to analyze the advantages of TESSYS minimally invasive endoscopic technique in the treatment of lumbar disc herniation compared with traditional surgery.Clinical Experience.Methods: A retrospective analysis of 88 patients who underwent single-segment surgery for lumbar disc herniation from January 2017 to January 2017 was divided into two groups according to the surgical procedure.One group was percutaneous transforaminal TESSYS technique.Nucleus pulposus removal,including 46 cases,28 cases of lesions were L4/5,18 cases of L5/S1;the other group was traditional posterior fenestration,including 42 cases,the lesion segment was L4/ There were 22 cases of L5 and 20 cases of L5/S1.The age,sex,duration of disease,surgical segment,operation time,intraoperative blood loss,hospitalization days and other related indexes were recorded.The patients were recorded before and after operation.The VAS score and ODI index of the time period were used to evaluate the surgical outcomes of the two groups at the last follow-up using the modified Macnab criteria.Spss23 was used for statistical analysis of all data.Results: A total of 88 patients were followed up for more than 12 months.The operation was successfully completed in both groups.The TESSYS group and the fenestration group were compared in age,gender,disease course and surgical segment,P>0.05.The difference was not statistically significant.The preoperative VAS scores of the TESSYS group and the fenestration group were(7.04±1.71)and(6.94±1.34),P>0.05,preoperative ODI dysfunction index was(63.76±6.48)% and(64.45±4.65)%,P>0.05,the difference was not statistically significant.The selected cases in the two groups were comparable.The operation time was(78.89±6.14)min in the TESSYS group and(74.05±5.95)min in the fenestration group,P>0.05.The difference was not statistically significant.The amount of bleeding and hospitalization in the TESSYS group were(21.63±4.34)ml,(3.93±1.062)days,respectively(97.73±19.14)ml,(11.76±1.77)days in the fenestration group;intraoperative hemorrhage in the TESSYS group the number of hospitalizations and hospital stays were significantly less than those of the fenestration group,P<0.05,and the difference was statistically significant.The VAS scores of the TESSYS group and the fenestration group were(2.28±0.81)points and(3.78±0.88)points,and the pain VAS scores of the TESSYS group were significantly lower than those of the fenestration group.The difference was statistically significant(P<0.05);however,the VAS scores in 7 days,3 months,and 12 months after operation compared in the TESSYS group were(1.84±0.63)(1.75±0.53)(1.04±0.57)(0.92±0.59).The fenestration group was(2.02±0.56)(1.88±0.56)(1.00±0.54)and(0.80±0.58),and the difference was not statistically significant(P>0.05).The ODI index of the 7th,3rd,6th,and 12 th months after TESSYS and open group were(34.28±4.88)% and(38.66±5.12)%,(26.16±5.96)% and(28.31±4.53)%,(22.91±3.34)% and(23.36±3.57)%,(22.46±4.25)% and(23.62±4.34)%,the difference between the two groups was not statistically significant(P>0.05).There were 2 cases of lower limb paresthesia and 2 cases of cerebrospinal fluid leakage after operation in the fenestration group.Three cases of lower limb numbness were found in the TESSYS group.After conservative treatment,the symptoms were alleviated.The surgical complications were 6.5% and 9.5%,respectively.P>0.05,the difference was not statistically significant.The modified Macnab score at the last follow-up: TESSYS group was excellent in 25 cases,good in 18 cases,fair in 3 cases,and poor in 0 cases;open window group was excellent in 16 cases,good in 22 cases,fair in 4 cases,and poor in 0 cases;93.4% and 90.4%,the difference was not statistically significant(Z =-1.490,P = 0.136).Conclusions:Percutaneous transforaminal TESSYS technique and traditional laminectomy can achieve satisfactory results in the treatment of LDH.There is no significant difference in VAS score,ODI index and complications between the two surgical procedures.TESSYS technique has obvious advantages in the surgical incision,intraoperative bleeding,hospitalization time,and it is a more minimally invasive surgery.