Abstract

We want to report about our experience after more than 800 transforaminal endoscopic surgeries in lumbar disc herniation. From 1999 until 2003 we used the intradiscal access with the YESS-technique in 300 cases with lumbar disc herniation. This technique was easy and safe, but the indication is limited. The access to level L5-S1 was nearly impossible in cases with high iliac crest and/or narrow foramen. The removing of sequestered disc material from the spinal canal was mostly impossible. From 2003 until today we used the extradiscal access with the TESSYS-technique in more than 500 cases. This technique is useable in nearly all cases of lumbar disc herniation and allows the direct access to the herniation by stepwise reaming and enlarging of the foramen. The results can be improved by the combination of herniotomy and foraminoplasty. Disadvantage of the method is the long learning curve. Most complications are recurrences (6,5%)and bleedings (1%). Nerve damages are rare (0,6%)and mostly after trouble with anesthesia