Transforaminal endoscopic stenosis surgery (TESS)

A new endoscopic procedure, the “Transforaminal Endoscopic Stenosis Surgery” (TESS), is presented. This technique is performed through a posterolateral transforaminal approach and allows widening the foramen in a collapsed lumbar disc by undercutting the superior facet under direct endoscopic control. A new endoscopic small reamer is used for this purpose that allows minimizing the aggression to the surrounding tissues.This study of 216 cases of lumbar foraminal stenosis compares the results of one group, in which the new endoscopic bone reamers were used for the foraminoplasty, with another group, in which only classical foraminoplasty was performed with a standard Holmium-YAG laser.Methods: 216 patients with lumbar foraminal stenosis underwent endoscopic spine surgery from 2003 to 2008 at Centro Medico Teknon in Barcelona (Spain). 125 patients underwent classical endoscopic surgery, thus, only a Ho-YAG laser was used for the foraminoplasty (Group A). 91 patients underwent TES surgery, hence, the new endoscopic bone reamers were used for the foraminoplasty (Group B).The inclusion criteria were: a) unilateral or bilateral radicular leg pain associated to image evidence of foraminal or lateral stenosis. b) Inadequate response to conservative treatment for > 6 months. All 216 procedures were performed in prone position and under local anesthesia. Pain was scored for every patient, preand post-operatively, with a Visual Analogic scale (VAS) and the disability with the Oswestry Disability Index (ODI). The post-operative scores were updated every 3 months. The mean follow-up period was 2.8 years (with a range of 6 61 months).Results: 216 patients who met the inclusion criteria underwent TES surgery. These 216 patients comprised 143 men and 73 women with ages ranging from 17 to 82 years (mean age 45.8 years). The overall results, evaluated according to Macnab criteria, for the 216 cases were: 151 excellent (69.9%), 45 good (20.8%), 16 fair (7.4%), 4 poor (1.9 %). Results for group A (125 cases): 90 excellent (72%), 20 good (16%), 14 fair (11.2%), 1 poor (0.8%). Results for group B (91 cases): 61 excellent (67%), 25 good (27.5%), 2 fair (2.2%), 3 poor (3.3%). The surgical time average was of approx. 50 min. for group A, while the surgical time average was of approx. 30 min. for group B.Conclusions: This study demonstrates the efficacy and efficiency of a new surgical technique (TESS) for foraminal stenosis that uses bone reaming under direct endoscopic control to widen the foramen in cases of foraminal or lateral stenosis. This endoscopic technique appears to be more accurate than other reaming techniques that only use X-ray C-arm control and have no direct endoscopic vision. Similar outcome and scoring results were achieved by the laser foraminoplasty and the reamed foraminoplasty but the latter was more efficient as it presented a lower average surgical time (approx. 20 min less) and lower material costs.This new endoscopic reaming technique opens the way for surgeons to primarily avoid more aggressive methods of decompression and minimize the surgical costs.