Abstract

Background: The purpose of this paper is to present a new endoscopic surgical procedure, the Transforaminal Endoscopic Spine Surgery (TESS), with a posterolateral transforaminal approach under endoscopic control and with minimal aggression to the surrounding tissues. This procedure consists of a new method of reamed foraminoplasty done under full endoscopic control while using a new endoscopic 3.5mm bone reamer for undercutting the superior facet. Methods: Fortyfour consecutive patients with foraminal stenosis underwent transforaminal endoscopic surgery (TESS) between March 2005 and July 2007. Inclusion criteria for TESS Surgery were: Unilateral radicular leg pain associated to foraminal stenosis. Inadequate response to conservative treatment for > 6 months. All 44 procedures were performed by the posterolateral transforaminal approach under endoscopic control. Bone reamers were used in order to perform foraminoplasty to allow the access to the intradiscal space or to the intracanal space. In all cases of foraminal stenosis with unilateral disc collapse and unilateral radiculopathy a reamed foraminoplasty was performed in order to decompress the exiting nerve root. Herniated nucleus or fragments, if present, were extracted. Results: Pain was scored with a Visual Analog Scale (VAS) and the disability was evaluated with the Oswestry index for every patient. The scoring and indexing were performed pre- and post-operatively. The postoperative scoring and indexing were updated every 3 months to achieve a minimal follow-up of 1.5 years for every case. The outcome of these 44 operated patients was: 28 excellent (63.8%), 9 good (20.5%), 4 fair (9.1%), 3 poor (6.8%). Conclusions: All 44 patients in this study were operated using a new endoscopic 3.5mm bone reamer for undercutting the superior facet under direct endoscopic vision. It is to be remarked that 29 patients were operated at level L5-S1. This proves to be a new promising technique, as it is very useful for narrow foramens in which the access is generally very difficult.