Background: With respect to percutaneous transforaminal endoscopic discectomy (PTED), safe and accurate needle puncture is a key element for determining the difficulty of surgery and can also influence clinical outcomes. The transforaminal puncture method currently employed in PTED depends on a constant distance from the midline and estimated angles in anteroposterior and craniocaudal directions. TSMP is an alternative concept of puncture based on Kambin’s triangle. TSMP references the natural anatomy of patients to progressively advance the needle to target. We herein discribed a three-step maneuver for puncture (TSMP) in PTED, which is possible to introduce the needle more safely and gain easy access to the herniated disc.
Methods: We performed a retrospective review of 30 patients who underwent PTED using TSMP for lumbar disc herniation (LDH) and met inclusion criteria from January 2018 to September 2018. The primary outcome, leg or back pain, was assessed using Visual Analogue Scale (VAS). Patient surgical satisfaction was measured at 12 months post surgery using a five-point Likert scale. Potential prognostic factors measured were demographic characteristics, duration of symptom (DOS), and involved levels. Statistical analysis was performed using Fisher exact test and t-test..
Results: Preoperative mean VAS was 7.6 ± 1.19, which decreased to 1.4 ± 0.97 at12 months following treatment (P < .0001). Rates of surgical satisfaction per Likert scale were as follows: very satisfied and satisfied in 26 patients (86.7%). VAS scores at 12 months varied significantly between L4-L5 level surgery and L5-S1 level surgery groups (P < .01).
Conclusion: TSMP is a reliable technique for puncture into the intervertebral foramen.