Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Current Reviews in Musculoskeletal Medicine
Published in: Current Reviews in Musculoskeletal Medicine 3/2019

01-09-2019 | Local Anesthesia in Dentistry | Minimally Invasive Spine Surgery (W Hsu, Section Editor)

Transforaminal full-endoscopic lumbar discectomy under local anesthesia in awake and aware conditions: the inside-out and outside-in techniques

Authors: Haruhiko Yoshinari, Fumitake Tezuka, Kazuta Yamashita, Hiroaki Manabe, Fumio Hayashi, Yoshihiro Ishihama, Kosuke Sugiura, Yoichiro Takata, Toshinori Sakai, Toru Maeda, Koichi Sairyo

Published in: Current Reviews in Musculoskeletal Medicine | Issue 3/2019

Login to get access

Abstract

Purpose of the review

Transforaminal full-endoscopic lumbar discectomy (TELD) under local anesthesia was first introduced in Japan in 2003. Initially referred to as percutaneous endoscopic discectomy, in 2018, a consensus was reached worldwide and the preferred term is now TELD. The procedure requires only an 8-mm skin incision and causes minimal damage to the paravertebral muscles. Thus, it is the least invasive disc surgery. In this review, we introduce two types of the TELD surgery.

Recent findings

Initially, TELD was performed as the “inside-out” technique but was associated with reports of postoperative dysesthesia due to exiting nerve injury. Recently, the “outside-in” technique after foraminoplasty was proposed for safer insertion of the cannula into the disc. Foraminoplasty can widen the narrow foramen, thereby allowing the 8-mm cannula to pass through easily and safely, and thus injury to the exiting nerve root can be theoretically avoided.

Summary

We described two types of the TELD in this review. Surgeons should be familiar with the inside-out and outside-in techniques for TELD; therefore, we can select appropriate technique for each case.
Literature
1.
Hijikata S. Percutaneous nucleotomy. A new concept technique and 12 years’ experience. Clin Orthop Relat Res. 1989;238:9–23.CrossRef
2.
Kambin P, Schaffer JL. Percutaneous lumbar discectomy. Review of 100 patients and current practice. Clin Orthop Relat Res. 1989;238:24–34.CrossRef
3.
Schreiber A, Leu H. Percutaneous nucleotomy: technique with discoscopy. Orthopedics. 1991;14(4):439–44.PubMed
4.
Yeung AT. The evolution of percutaneous spinal endoscopy and discectomy: state of the art. Mt Sinai J Med. 2000;67:327–32.PubMed
5.
Yeung AT, Tsou PM. Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases. Spine. 2002;27:722–31.CrossRefPubMed
6.
Yeung AT, Yeung CA. Minimally invasive techniques for the management of lumbar disc herniation. Orthop Clin North Am. 2007;38(3):363–72.CrossRefPubMed
7.
Dezawa A. Office-based surgery for the percutaneous endoscopic laminectomy and discectomy (in Japanese). Orthop Surg Traumatol. 2016;59:254–9.
8.
Sairyo K, Nagamachi A. State-of-the-art management of low back pain in athletes: instructional lecture. J Orthop Sci. 2016;21(3):263–72.CrossRefPubMed
9.
Ruetten S, Komp M, Merk H, Godolias G. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine (Phila Pa 1976). 2008;33:931–9.CrossRef
10.
Birkenmaier C, Komp M, Leu HF, Wegener B, Ruetten S. The current state of endoscopic disc surgery: review of controlled studies comparing full-endoscopic procedures for disc herniations to standard procedures. Pain Physician. 2013;16:335–44.PubMed
11.
Hsu HT, Chang SJ, Yang SS, Chai CL. Learning curve of full-endoscopic lumbar discectomy. Eur Spine J. 2013;22(4):727–33.CrossRefPubMed
12.
Dezawa A, Sairyo K. New minimally invasive endoscopic discectomy technique through the interlaminar space using a percutaneous endoscope. Asian J Endosc Surg. 2011;4(2):94–8.CrossRefPubMed
13.
Koga S, Sairyo K, Shibuya I, Kanamori Y, Kosugi T, Matsumoto H, et al. Minimally invasive removal of a recurrent lumbar herniated nucleus pulposus by the small incised microendoscopic discectomy interlaminar approach. Asian J Endosc Surg. 2012;5(1):34–7.CrossRefPubMed
14.
Ruetten S, Komp M, Merk H, Godolias G. Use of newly developed instruments and endoscopes: full-endoscopic resection of lumbar disc herniations via the interlaminar and lateral transforaminal approach. J Neurosurg Spine. 2007;6(6):521–30.CrossRefPubMed
15.
• Kim HS, Adsul N, Kapoor A, Choi SH, Kim JH, Kim KJ, Bang JS, Yang KH, Han S, Lim JH, Jang JS, Jang IT, Oh SH. A Mobile outside-in technique of transforaminal lumbar endoscopy for lumbar disc herniations. J Vis Exp 2018;(138). (This is very important paper describing the outside in technique.)
16.
Choi KC, Lee DC, Shim HK, Shin SH, Park CK. A strategy of percutaneous endoscopic lumbar discectomy for migrated disc herniation. World Neurosurg. 2017 Mar;99:259–66.CrossRefPubMed
17.
Gore S, Yeung A. The “inside out” transforaminal technique to treat lumbar spinal pain in an awake and aware patient under local anesthesia: results and a review of the literature. Int J Spine Surg. 2014;8:28 Published online 2014 Dec 1.CrossRefPubMedCentral
18.
Morgenstern R, Morgenstern C, Yeung AT. The learning curve in Foraminal endoscopic discectomy: experience needed to achieve a 90% success rate. SAS J. 2007;1(3):100–7 Published online 2007 Aug 1.CrossRefPubMedPubMedCentral
19.
Sairyo K, Matsuura T, Higashino K, Sakai T, Takata Y, Goda Y, et al. Surgery related complications in percutaneous endoscopic lumbar discectomy under local anesthesia. J Med Investig. 2014;61(3–4):264–9 Review.CrossRef
20.
Choi I, Ahn JO, So WS, Lee SJ, Choi IJ, Kim H. Exiting root injury in transforaminal endoscopic discectomy: preoperative image considerations for safety. Eur Spine J. 2013;22(11):2481–7.CrossRefPubMedPubMedCentral
21.
Choi G, Kang HY, Modi HN, Prada N, Nicolau RJ, Joh JY, et al. Risk of developing seizure after percutaneous endoscopic lumbar discectomy. J Spinal Disord Tech. 2011;24(2):83–92.CrossRefPubMed
22.
Ahn Y, Oh HK, Kim H, Lee SH, Lee HN. Percutaneous endoscopic lumbar foraminotomy: an advanced surgical technique and clinical outcomes. Neurosurgery. 2014;75(2):124–33 discussion 132-3.CrossRefPubMedPubMedCentral
23.
Henmi T, Terai T, Hibino N, Yoshioka S, Kondo K, Goda Y, et al. Percutaneous endoscopic lumbar discectomy utilizing ventral epiduroscopic observation technique and foraminoplasty for transligamentous extruded nucleus pulposus: technical note. J Neurosurg Spine. 2015;13:1–6.
24.
• Henmi T, Terai T, Nagamachi A, Sairyo K. Morphometric changes of the lumbar intervertebral foramen after percutaneous endoscopic foraminoplasty under local anesthesia. J Neurol Surg A Cent Eur Neurosurg. 2017;79:019–24. https://​doi.​org/​10.​1055/​s-0037-1599059. (This is important paper. They described the effects of the foraminoplasty on the safe surgery. CrossRef
25.
Lewandrowski KU. “Outside-in” technique, clinical results, and indications with transforaminal lumbar endoscopic surgery: a retrospective study on 220 patients on applied radiographic classification of foraminal spinal stenosis. Int J Spine Surg 2014 ;8. https://​doi.​org/​10.​14444/​1026. eCollection 2014
26.
Tezuka F, Sugiura K, Ishihama Y, Manabe H, Hayashi F, Yamashita K, Takata Y, Sakai T, Chikawa T, and Sairyo K. Transforaminal percutaneous endoscopic lumbar discectomy using foraminoplastic outside-in technique under local anesthesia. The 18th Annual Meeting of the Pacific and Asian Society of Minimally Invasive Spine Surgery at Kaohsiung, Taiwan July 19 to 21, 2018.
27.
• Tezuka F, Sakai T, Abe M, Yamashita K, Takata Y, Higashino K, et al. Anatomical considerations of the iliac crest on percutaneous endoscopic discectomy using a transforaminal approach. Spine J. 2017;17(12):1875–80 (This is important paper. They described why we need foraminoplasty for the L5-s level anatomically.).CrossRefPubMed
28.
Choi KC, Park CK. Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation: consideration of the relation between the iliac crest and L5-S1 disc. Pain Physician. 2016;19(2):E301–8.PubMed
29.
Abe M, Takata Y, Higashino K, Sakai T, Matsuura T, Suzue N, et al. Foraminoplastic transforaminal percutaneous endoscopic discectomy at the lumbosacral junction under local anesthesia in an elite rugby player. J Med Investig. 2015;62(3–4):238–41.CrossRef
30.
• Sairyo K, Chikawa T, Nagamachi A. State-of-the-art transforaminal percutaneous endoscopic lumbar surgery under local anesthesia: discectomy, foraminoplasty, and ventral facetectomy. J Orthop Sci. 2018;23(2):229–36 (this is very important paper, which describes TELD technique and foraminoplasty). CrossRefPubMed
Metadata
Title
Transforaminal full-endoscopic lumbar discectomy under local anesthesia in awake and aware conditions: the inside-out and outside-in techniques
Authors
Haruhiko Yoshinari
Fumitake Tezuka
Kazuta Yamashita
Hiroaki Manabe
Fumio Hayashi
Yoshihiro Ishihama
Kosuke Sugiura
Yoichiro Takata
Toshinori Sakai
Toru Maeda
Koichi Sairyo
Publication date
01-09-2019
Publisher
Springer US
Published in
Current Reviews in Musculoskeletal Medicine / Issue 3/2019
Electronic ISSN: 1935-9748
DOI
https://doi.org/10.1007/s12178-019-09565-3

Other articles of this Issue 3/2019

Current Reviews in Musculoskeletal Medicine 3/2019 Go to the issue

Femoroacetabular impingement/labral tears (A Zhang, Section Editor)

Surgical Treatment of Labral Tears: Debridement, Repair, Reconstruction

Outcomes Research in Orthopedics (O Ayeni, Section Editor)

The Clinical Use of Biologics in the Knee Lesions: Does the Patient Benefit?

Concussion (C Senter and M Kapadia, Section Editors)

Current Concepts in the Evaluation of the Pediatric Patient with Concussion

Femoroacetabular impingement/labral tears (A Zhang, Section Editor)

Contemporary Management of the Hip Capsule During Arthroscopic Hip Preservation Surgery

Distal Radius and Wrist Fractures (E Shin, Section Editor)

Management of High Energy Distal Radius Injuries

Femoroacetabular impingement/labral tears (A Zhang, Section Editor)

Surgical Treatment for FAI: Arthroscopic and Open Techniques for Osteoplasty