G Krzok. Endoscopy – Follow up after 800 patients.. The Internet Journal of Minimally Invasive Spinal Technology. 2008 Volume 3 Number 4.
Endoscopic surgery of lumbar disc herniation has been rapidly developed in the last 20 years because of the well known problems of open disk surgery, especially the formation of scarf tissue with adhesions of dura and nerves. Minimally invasive surgery could prevent the problems and should be achieve better results. Endoscopic surgery doesn`t lead to the damage of musculature and ligaments and finally reduce bleedings. General anaesthesia is not necessary. The equipment must be at the latest level. I want to talk about my own experience und the results after 800 lumbar endoscopic disc surgeries.From 1999 until 2003 we used the YESS-technique of Anthony Yeung – that means inside-outside-technique with mainly intradiscal nucleotomy under endoscopic view.This method is relatively easy and safe. It was an outpatient procedure. Indications are protrusions, contained herniations and intra- and extraforaminal herniations. The results after 300 surgeries with YESS-technique showed good results in 88,7% after one year.The indication was limited. The technique was not suitable for dorsal or cranial migrated herniations. The access to level L5-S1 in cases of high iliac crest and/or narrow foramen was too difficult or impossible.Complications were rare, one case with spondylodiscitis. The recurrence rate was 7,3%. After the IITS-congress in Munich 2003 we began with the modified TESSYS-technique, original developed by Thomas Hoogland. Until today we have made more than 500 cases by using this technique.In contrast to the YESS-technique the TESSYS-technique allows transforaminal endoscopic approach. Direct access to the sequester in the spinal canal is possible byincreasing of the foramen step by step with special reamers. Nearly all types of lumbar disc herniations are treatable with this technique.Nucleotomy of level L5-S1 is easier by using the rod with the bended tip to enter the foramen followed by stepwise reaming .Results after follow up of one year showed good and excellent results in 87,6% (Mc.Nab-Score). The recurrence rate was 6,5%. There was no infection found.Disadvantage is the long learning curve. Most complications of surgery were found after problems with the anaesthesia. Team work of surgeon and anaesthesiologist is very necessary.