Simplifying Transforaminal Endoscopic Lumbar Discectomy (TELD) Through the Guiding Framework of Ten Landmarks.

Abstract

Aim: To streamline the transforaminal endoscopic lumbar discectomy (TELD) technique to facilitate a shorter learning curve for novice surgeons by providing a comprehensive guide featuring ten crucial landmarks.

Material and methods: In this retrospective study, we reviewed patients diagnosed with lumbar disc herniation who underwent navigational TELD using ten landmarks from September 2021 to October 2022. We compared these patients with those who received conventional TELD from June 2020 to August 2021. A comprehensive account of the TELD surgical procedure, outlining each stage and introducing ten critical landmarks as surgical aids, is presented. Comparative analyses were conducted between the navigational and conventional groups, focusing on operation duration and fluoroscopic exposure.

Results: There were no statistically significant differences observed between the navigational and conventional groups with regard to gender, age, and intraoperative VAS (visual analog scale) scores. The operation time and fluoroscopic exposures in the navigational group were notably reduced, measuring 56.33 ± 9.90 minutes and 4.97 ± 1.53, respectively, compared to 71.73 ± 17.80 minutes and 6.44 ± 1.52 in the conventional group (p < 0.05). Both groups exhibited no significant disparity in VAS and ODI (Oswestry disability index) scores. Nevertheless, postoperatively, at both 1 day and 3 months, both groups demonstrated lower VAS and ODI scores in comparison to preoperative values. Notably, the scores at 3 months post-surgery were significantly lower than those recorded at 1 day post-surgery (p < 0.05).

Conclusion: The implementation of guiding landmarks significantly streamlines and simplifies the TELD procedure. It substantially decreases operation duration, minimizes fluoroscopy usage, enhances surgical safety, and ensures consistent clinical effectiveness. These landmarks enable novice surgeons to master TELD more easily.