Tessys method

The Tessys method (Transforaminal Endoscopic Surgical System) is a minimally invasive surgical procedure for the endoscopic removal of a herniated disc . However , it has not yet been proven to be superior to open microdisectomy .

concept

In the Tessys method, the surgeon removes a herniated disc via the lateral transforaminal endoscopic approach. This surgical approach is particularly gentle on the patient. The patient is in a stable side or prone position and can be approached at all times during the operation thanks to analgesic sedation - so he does not need general anesthesia. The surgeon removes the leaked intervertebral disc tissue through an incision only millimeters in size through the intervertebral foramen ( foramen intervertebrale ). He pushes muscles and connective tissue to the side and gradually expands the foramen through a working sleeve with special instruments. The Tessys operation method is used in both hospitals and outpatient operation centers and is remunerated in Germany according to DRG flat rates .

history

The Tessys process was developed in Germany in the 2000s. In 2011 there were around 50 clinics and centers in Germany that use the Tessys method, and around 200 clinics and centers worldwide.

indication

With the Tessys method, surgeons can remove almost all herniated discs and disc sequesters, regardless of their position, through the lateral transforaminal access under analgesic sedation.

Indications for a Tessys surgical method are when conservative therapies cannot improve the pain, when surrounding nerves are impaired or paralysis is already occurring. A cauda equina syndrome represents an immediate surgical indication. Each disc surgery, so a TESSYS engagement, needs to be in an extensive patient call, and by a magnetic resonance imaging (MRI) and / or computed tomography as well as by various conventional radiographs be carefully clarified.

The intraoperative discography or chromography provides ultimate certainty with regard to the unambiguous location of the herniated disc.

Surgical procedure

With the Tessys endoscopic operating system, the surgeon removes a herniated disc through a lateral endoscopic access path through the intervertebral hole . The procedure takes about 45 minutes. During the operation, the patient is in a stable side or prone position. Access is based on a three-stage guide wire principle. The surgeon expands the tissue gradually and under constant x-ray control. Nerves and muscles should thus remain unharmed. The doctor enlarges the foramen millimeter by millimeter with special small milling instruments. The intervertebral hole is expanded in this way without significantly impairing the stability of the spine.

The endoscope has a working channel through which various fine instruments can be inserted. The surgeon pushes the endoscope through a working sleeve into the operating area. The camera delivers the images of the operation.

Studies

Studies have already been carried out on advances and successes in minimally invasive endoscopic disc surgery, but further investigations are required in order to be able to assess the success and complication rate in terms of EBM . However, it has not yet been possible to demonstrate that the Tessys method is superior to the conventional approach.

Individual evidence

1. ↑ ^{a b} J. Nellensteijn, R. Ostelo, R. Bartels, W. Peul, B. van Royen, M. van Tulder: Transforaminal endoscopic surgery for symptomatic lumbar disc herniations: a systematic review of the literature. In: European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. Volume 19, number 2, February 2010, pp. 181-204, doi: 10.1007 / s00586-009-1155-x , PMID 19756781 , PMC 2899820 (free full text) (review).
2. ↑ Michael Schubert, Dr. Armin Helmbrecht; Transforaminal endoscopic lumbar nucleotomy for all types of herniated discs. In Chirurgische Allgemeine 10/2010, pp. 519-526, ISSN  1615-5378
3. ↑ M. Iprenburg and A. Godschalx; Transforaminal Endoscopic Surgery in Lumbar Disc Herniation in an Economic Crisis - The TESSYS Method. In US Musculoskeletal Review 2008, PDF
4. ↑ M. Iprenburg; Transforaminal Endoscopic Surgery - Technique and Provisional Results in Primary Disc Herniation. In European Musculoskeletal Review 2007, PDF
5. ↑ F. Alfen et al .; Developments in the Area of ​​Endoscopic Spine Surgery. In European Musculoskeletal Review 2006.

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