gms | German Medical Science

Background: 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 established the TESSYS technique in a university hospital setting and report our experiences from the first 2 years.

Materials and methods: From February 2013 to February 2015 we used TESSYS for lumbar sequestrectomy in 33 patients. Electronic records were retrospectively analyzed with regard to demographic, radiological, as well as intraoperative and postoperative data. 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) that was distributed in May 2015.

Results: The median age of our cohort was 52 years, the median follow-up was 19.5 months and was completed by 24 patients. The median hospital stay was 4 days. Surgery was most commonly performed at level L 4/5 (61%) in caudally migrated disc herniations (45%). 4 of the 33 cases had previously been operated at the same level. The average operation time was 107 minutes (no significant change during course of study) with a blood loss of 70 ml. The procedure had to be changed to microsurgical tubular sequestrectomy in 2 patients. There were no major complications and minor complications occurred in 3 patients; in 2 of these patients a microsurgical reoperation had to be carried out. At discharge and at LFU 97% and 75% of the patients had an excellent or good clinical outcome according to the Macnab criteria, respectively. 92% of the patients stated that they would again consent to a TESSYS operation.

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 results are promising.