Transforaminal endoscopic system technique for discogenic low back pain: A prospective Cohort study

• The diagnosis and treatment for discogenic low back pain (DLBP) are controversial.
• TESSYS is an effective treatment for the treatment of DLBP.
• A complete management of the inflammatory granuloma is the key point in treating DLBP.

ObjectiveTo investigate the clinical outcomes of transforaminal endoscopic system(TESSYS) for discogenic low back pain(DLBP).Methods62 consecutive patients with one-level DLBP applying to the including criteria underwent TESSYS from January 2010 to December 2013. These patients included 38 males and 24 females with a mean age of 42.7 ± 5.4 years (range, 18–73 yr) and a mean follow-up of 26.8 ± 4.2 months (range, 12–48 months). The visual analog scale (VAS) were used for back pain, the Oswestry Disability Index (ODI) for lumbar function, and the modified MacNab criteria for clinical global outcomes.Results24 patients showed only inflammatory granuloma on annulus tear tissues(Group A), 16 patients showed no annulus tear but adhesion and inflammatory granuloma among the intracanal annulus fibrous(AF), posterior longitudinal ligament(PLL) and the abdomen side of the dura sac(Group B) and 22 patients showed both(Group C). Concordant pain could be triggered by touching the inflammation with the bipolar radiofrequency probe. The success rate (excellent and good) of group C was much higher than A and B(P < 0.05). The whole success rate was 75.8%. Of the 4 patients with poor result, 2 refused further surgical treatment and showed either no improvement or worsening. The remaining 2 patients had spinal fusion surgery and achieved better results. VAS and ODI had significantly improved after surgery (P < 0.01). No unexpected complications were seen.ConclusionTEEYS is an effective method in treating DLBP and the complete management of the inflammatory granuloma was the key point in achieving better results.