Trans-foraminal endoscopic disc surgery (TESSYS) has now matured into a highly successful, minimal disruption procedure that can be performed as a day case with the patient mobile almost immediately and fit for discharge within 2 hours post operation. The procedure is done without the need of a full anaesthetic with local anaesthetic and sedation.
- Reduced length of stay in hospital
- high patient satisfaction
- improvements in quality of life scores
- lower revision rate
- lower rate of dural tears
- lower infection rate
- reduced post operative pain
The patient is positioned in the lateral or prone position. The entry point is marked by the surgeon, and the guide wire is placed.
The surgeon places a series of graduated guiding rods and tubes over the guide wire, followed by the working tubes. The iLESSYS® instrument set enables the epidural space and the spinal canal to be entered under endoscopic control. Little or no bone material is removed.
Laminoscopes are used to decompress the disc prolapse under endoscopic image control. Post-operative pain is generally minimal.
Sciatica is usually caused by a prolapsed disc in the lumbar spine. This is a common cause of back pain that often progresses to leg pain (sciatica) due to compression of a nerve root.
Many cases of sciatica resolve with time and conservative measures. The majority of patients with severe acute (recent onset) sciatica will improve spontaneously. Those that don't may be suitable for a spinal injection (epidural; nerve root block; foraminal injection).
If that doesn't relieve the symptoms then surgery may be indicated.
Traditionally, the surgical treatment is called discectomy or microdiscectomy. In the latter, a smaller incision is possible as the surgeon will use magnification with a microscope or loopes. All these procedures are open operation which inevitably causes some muscle and bone damage. They also necessitate the manipulation of the nerves to allow access to the disc protrusion. These manoeuvres can lead to scarring and ongoing pain.
Minimal invasive techniques have been developed and endoscopic surgery is now becoming increasingly popular due to advantages of no muscle damage, no manipulation of delicate nerves and reduced scarring of all these tissues. The development of high definition cameras has allowed the use of smaller scopes.