Related Experiment Video
Updated: May 9, 2026
Transtubular Endoscopic Posterolateral Decompression for L5-S1 Lumbar Lateral Disc Herniation
Published on: October 14, 2022
A novel transparent visual channel translates into enhanced surgical safety and efficiency for prolapsed lumbar disc
Junwei Zhang1, Gen Li1, Yang Sun2
1Department of Orthopedics, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
Background:
The standard metal working channel in percutaneous translaminar endoscopic discectomy (PTED) creates a significant visual "blind spot," presenting a particular challenge during surgery for prolapsed lumbar disc herniation (PLDH). This obstruction can result in semi-blind surgical maneuvers, elevating the risk of neural injury and incomplete fragment removal. To overcome this fundamental limitation, we developed a novel transparent visual channel (TVC) and assessed its clinical performance.
Methods:
In a retrospective comparative study, we analyzed 65 patients with PLDH who underwent PTED, utilizing either the novel TVC (n = 29) or the conventional metal working channel (n = 36). Key metrics for comparison included surgical field of view (quantified using the structural similarity index measure [SSIM]), total operation time, frequency of intraoperative neurophysiological monitoring alerts, standard perioperative clinical indicators, complication rates, and patient-reported outcomes (Visual Analog Scale [VAS] for pain, Oswestry Disability Index [ODI], and MacNab criteria).
Results:
The TVC group demonstrated a significantly larger and more consistent surgical field of view, evidenced by a markedly higher SSIM (98.2% ± 1.1% vs. 54.6% ± 8.3%, P < 0.05). Operative efficiency was improved in the TVC group, with a significantly shorter mean operation time (83.2 ± 9.7 min vs. 97.5 ± 8.9 min, P < 0.05). Critically, the use of the TVC was associated with enhanced intraoperative safety, as indicated by a significant reduction in the number of intraoperative neurophysiological monitoring alerts during neural decompression (2 vs. 11, P < 0.05). Both groups exhibited significant and comparable improvements in VAS scores, ODI scores, and MacNab outcomes at follow-up, with no statistically significant differences between the groups (P > 0.05).
Conclusion:
The novel transparent visual channel effectively converts the PTED procedure from a semi-blind technique to a fully visualized one. This material innovation delivers direct clinical advantages by improving intraoperative safety through reduced neural irritation and increasing procedural efficiency, all while maintaining the excellent clinical outcomes associated with standard PTED. This study substantiates the TVC as a significant advancement in endoscopic spine surgery instrumentation, directly addressing a core visual constraint of the established technique.
