Elsevier

World Neurosurgery

Volume 119, November 2018, Pages e53-e59
World Neurosurgery

Original Article
Effectiveness of Bi-Needle Technique (Hybrid Yeung Endoscopic Spine System/Transforaminal Endoscopic Spine System) for Percutaneous Endoscopic Lumbar Discectomy

https://doi.org/10.1016/j.wneu.2018.06.220Get rights and content

Highlights

  • The new bi-needle technique combines the advantages of YESS and TESSYS techniques.

  • Location and decompression of protruding nucleus pulposus is performed more accurately and quickly by 2 needles.

  • Compared with TESSYS, operative time of bi-needle technique is shorter, and recurrence and reoperation rates are lower.

Objective

The bi-needle technique is a new technique for percutaneous endoscopic lumbar discectomy. This technique combines the advantages of Yeung endoscopic spine system (YESS) and transforaminal endoscopic spine system (TESSYS) techniques. The aim of this study was to evaluate effectiveness of the bi-needle technique for percutaneous endoscopic lumbar discectomy and compare it with the TESSYS technique.

Methods

We reviewed 86 patients with single-level lumbar disc herniation treated by percutaneous endoscopic lumbar discectomy in our hospital from June 2013 to December 2015. Bi-needle technique was used in 49 patients (30 men, 19 women; average age 40.4 ± 5.2 years). TESSYS technique was used in 37 patients (19 men, 18 women; average age 42.8 ± 6.4 years). Clinical results were evaluated and compared between the 2 groups.

Results

Symptoms in both groups were significantly improved at the last follow-up (P < 0.01). There was no statistical difference in visual analog scale and lumbar Japanese Orthopaedic Association scores between bi-needle and TESSYS groups at last follow-up (P = 0.69 and P = 0.33, respectively). Operative time was shorter in the bi-needle group (P < 0.01). Recurrence rate and reoperation rate were lower in the bi-needle group (P = 0.04 and P = 0.03, respectively). Discitis was diagnosed in 2 patients in the TESSYS group. There were no patients with postoperative discitis in the bi-needle group.

Conclusions

The bi-needle technique is safe and effective for treatment of lumbar disc herniation. Compared with TESSYS technique, operative time is shorter, and recurrence and reoperation rates are lower.

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)

  • H.S. Kim et al.

    Comparative assessment of different percutaneous endoscopic interlaminar lumbar discectomy (PEID) techniques

    Pain Physician

    (2013)
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    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.

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