[Comparison of effectiveness between visualized reamer foraminoplasty and transforaminal endoscopic spine system...

To evaluate the effectiveness of visualized reamer foraminoplasty in transforaminal endoscopic lumbar discectomy (TELD) for the treatment of lumbar disc herniation (LDH).

A retrospective analysis was conducted on the clinical data of 100 LDH patients who met the selection criteria and underwent TELD between January 2022 and June 2024. According to the foraminoplasty technique, patients were divided into a visualized group and a transforaminal endoscopic spine system (TESSYS) group, with 50 patients in each group. There were no significant differences in baseline data between the two groups ( P>0.05), including gender, age, surgical level, disease duration, preoperative visual analogue scale (VAS) scores for low back and lower limb pain, and Oswestry disability index (ODI). The intraoperative fluoroscopy frequency, operation time, intraoperative blood loss, hospital stay, time from operation to discharge, and complications were recorded and compared between the two groups. Low back and lower limb pain were assessed using VAS scores, and function status was evaluated using ODI preoperatively and at 1 day, 1, 3, 6, and 12 months postoperatively. Surgical outcomes were evaluated at last follow-up using the modified MacNab criteria.

All surgeries were completed successfully, with primary healing of the incisions. The visualized group showed significantly shorter operation time and fewer fluoroscopy frequencies than the TESSYS group ( P<0.05). No significant differences were found between the two groups in intraoperative blood loss, time from operation to discharge, or hospital stay ( P>0.05). One case of recurrence occurred in the visualized group, compared to 3 cases in the TESSYS group, with no significant difference between the groups ( P>0.05). Postoperative lower limb dysesthesia occurred in 4 cases in the TESSYS group, but was not observed in the visualized group, showing a significant difference ( P<0.05). No other complications, such as vascular injury, cerebrospinal fluid leakage, incisional hematoma, or infection occurred in either group. Both groups showed significant improvement in low back VAS score, lower limb VAS score, and ODI at all postoperative time points compared to preoperative values ( P<0.05). No significant difference was found in low back VAS score, lower limb VAS score, or ODI between the two groups at any postoperative time point ( P>0.05). According to the modified MacNab criteria at last follow-up, the excellent-good rates were 96% and 92% in the visualized and TESSYS groups, respectively, with no significant difference ( P>0.05).

Both TESSYS and visualized reamer foraminoplasty techniques yield satisfactory outcomes in the treatment of LDH via TELD. The latter can significantly reduce intraoperative fluoroscopy frequency and operation time, but the effectiveness of the two groups is comparable.