Original ArticleEffectiveness of Bi-Needle Technique (Hybrid Yeung Endoscopic Spine System/Transforaminal Endoscopic Spine System) for Percutaneous Endoscopic Lumbar Discectomy
Introduction
The Yeung endoscopic spine system (YESS) and transforaminal endoscopic spine system (TESSYS) techniques are 2 of the most important percutaneous endoscopic lumbar discectomy (PELD) techniques for management of lumbar disc herniation (LDH).1, 2 The YESS technique is an “inside to outside” technique. In this technique, the working cannula is inserted into the intervertebral disc. Discectomy and decompression are then performed from inside of the intervertebral disc to the spinal canal.3 This technique is a relatively simple procedure, especially for contained disc herniation, with low risk of nerve root injury and less bleeding. However, because of a steep approach and minor facetectomy, the YESS technique is usually not indicated for extruded disc or sequestered disc herniation. In the TESSYS technique, the working cannula enters the spinal canal through the Kambin triangle.4 This technique has the advantage of direct exploration of the extruded disc and release of the nerve root within the spinal canal.4, 5 However, the TESSYS technique is relatively complicated, needs much more C-arm fluoroscopy time, and usually has a longer learning curve.6, 7 In addition, recurrence of symptoms after surgery is still a problem in PELD.8 Therefore, although these 2 techniques are effective, they are still not ideal.
The bi-needle technique is a new technique for PELD. This technique combines the advantages of YESS and TESSYS techniques. In the bi-needle technique, 2 needles are used for localization, discography, and decompression of the herniated disc. Needle A is inserted as in the YESS technique and used for intraoperative methylene blue injection. Needle B is inserted as in the TESSYS technique and used for placement of the working cannula and subsequent nerve decompression. As a result of the combination of the 2 needles, chromodiscography can be performed using needle A under direct visualization through endoscopy, by which PELD can be performed more accurately and quickly. To evaluate the effectiveness of the bi-needle technique for PELD, a retrospective study was performed. Outcomes of the bi-needle technique were evaluated and compared with the TESSYS technique.
Section snippets
Demographic Characteristics
This retrospective study reviewed 86 patients with LDH treated with PELD in our hospital from June 2013 to December 2015. All patients had single-level LDH with typical symptoms of low back pain, radiating pain, and numbness in the lower extremity along the sciatic nerve distribution. Positive Lasègue sign, muscle weakness, and hypoactive tendon reflexes were found on physical examination.
All patients received conservative treatment before surgery, and surgery was indicated if conservative
Discussion
Minimally invasive surgery is an important development trend for treatment of spinal diseases. In recent years, PELD for patients with symptomatic LDH has become increasingly popular.10, 11 Because of its advantages owing to minimal invasiveness, more and more patients are willing to accept PELD rather than traditional open surgery. Also, numerous studies have confirmed the effectiveness and safety of PELD for LDH.12, 13 With improvements in surgical techniques and related instruments,
Conclusions
The bi-needle technique is safe and effective for treatment of LDH. Compared with TESSYS technique, operative time of the bi-needle technique is shorter, and recurrence and reoperation rates are lower.
References (23)
- et al.
Transforaminal endoscopic spinal surgery: the future “gold standard” for discectomy? A review
Surgeon
(2012) - et al.
Fully endoscopic interlaminar and transforaminal lumbar discectomy: short-term clinical results of 163 surgically treated patients
World Neurosurg
(2014) - et al.
Full endoscopic contralateral transforaminal discectomy for distally migrated lumbar disc herniation
J Orthop Sci
(2011) - et al.
Transforaminal endoscopic surgery for lumbar stenosis: a systematic review
Eur Spine J
(2010) Minimally invasive disc surgery with the Yeung endoscopic spine system (YESS)
Surg Technol Int
(1999)- et al.
Advances in endoscopic disc and spine surgery: foraminal approach
Surg Technol Int
(2003) - et al.
Efficacy of transforaminal endoscopic spine system (TESSYS) technique in treating lumbar disc herniation
Med Sci Monit
(2016) - et al.
A meta-analysis of endoscopic discectomy versus open discectomy for symptomatic lumbar disk herniation
Eur Spine J
(2016) - et al.
Transforaminal percutaneous endoscopic discectomy using transforaminal endoscopic spine system technique: pitfalls that a beginner should avoid
World J Orthop
(2017) - et al.
Learning curves of percutaneous endoscopic lumbar discectomy in transforaminal approach at the L4/5 and L5/S1 levels: a comparative study
J Zhejiang Univ Sci B
(2016)
Comparative assessment of different percutaneous endoscopic interlaminar lumbar discectomy (PEID) techniques
Pain Physician
Cited by (10)
Learning Curve for Percutaneous Endoscopic Lumbar Diskectomy in Bi-needle Technique Using Cumulative Summation Test for Learning Curve
2019, World NeurosurgeryCitation Excerpt :It was demonstrated that this hybrid surgical approach was more effective than TESSYS or YESS alone. When using the bi-needle technique, Wu et al10 proposed a combination surgical strategy to achieve intraoperative discography via YESS and targeted diskectomy via TESSYS. Integration of these 2 techniques helps to save operative time and prevent redundant radiographs.
Global Trends and Hotspots of Minimally Invasive Surgery in Lumbar Spinal Stenosis: A Bibliometric Analysis
2024, Journal of Pain ResearchRisk Factors for Short-Term and Long-Term Low Back Pain After Transforaminal Endoscopic Lumbar Discectomy
2023, Journal of Pain ResearchEffect of medium with moderate temperature on patient's body temperature during percutaneous endoscopic lumbar discectomy
2022, Journal of Orthopaedic Surgery and Research
Conflict of interest statement: This work was supported by the National Natural Science Foundation of China (Grant No. 31200718).
Xiao-Dong Wu, Yu Chen, and Wen-Chao Yu are co–first authors.