Video-assisted thoracoscopy was first performed for discectomy and fusion on the thoracic spine in 1993, thoracoscopic technology has evolved significantly over time. In 2002, Dutch Dr Thomas Hoogland introduced the THESSYS technique based on the YESS technique, which advanced the maturity of transforaminal endoscopic spine surgery. This technique is now widely used to treat cervical and lumbar spine diseases. With advantages such as minimal trauma, reduced bleeding, rapid recovery, and significant efficacy, it has gradually become the preferred treatment option for an increasing number of patients with cervical and lumbar spine conditions. 

New trends in the treatment of cervical and lumbar spine diseases

Definition
 

Transforaminal endoscopic spine surgery is a technique that uses endoscopic technology to access the spinal canal through a puncture channel with a diameter of only 6-8 millimeters. An endoscope is inserted into the spinal canal, allowing clear visualization of the structures within the canal via an imaging system. This includes herniated intervertebral discs, compressed nerve roots, the dural sac, blood vessels, the yellow ligament, and ossified tissue. Under the guidance of imaging equipment, the surgeon performs procedures within the spinal canal using fine instruments, such as disc forceps, bone drills, and electric burrs, to remove herniated disc tissue. The entire surgical process is completed through an incision of about 8 mm, significantly reducing damage to surrounding healthy tissues. Patients typically can begin to move around a few hours after the surgery.

Classification

YESS technique	THESSYS technique
Intervertebral disc	Spinal canal
Narrow indications	Effectively addresses conditions such as extruded and free-floating lumbar disc tissue, central spinal canal stenosis, and lateral recess stenosis.
It is particularly challenging for treating disc herniations in areas with high iliac crests and narrow intervertebral foramina.	Resection of part of the facet joint protrusion and expansion of the intervertebral foramen.
The procedure is relatively straightforward, making it suitable for novice surgeons.	The procedure is complex

Transforaminal endoscopic spine surgery vs. conventional surgery

	Transforaminal endoscopic spine surgery	Conventional surgery
Extent of Harm to the Body	Small incision, short treatment time, fast recovery, and minimal damage to the body.	Large incision, longer surgery time, extended recovery period, and significant bodily damage.
Safety	High safety: local anesthesia, no damage to nerves and blood vessels.	Lower Safety: General anesthesia may pose risks of nerve and blood vessel damage.
Treatment Characteristics	Minimal trauma, with blood loss of less than 20 ml, precise localization, no damage to surrounding healthy tissue cells, significantly reducing side effects and postoperative infection rates.	Open surgery, greater trauma, higher blood loss, potential damage to surrounding healthy tissues, and increased risk of postoperative infection.

Transforaminal endoscopic spine surgery features minimal trauma, significant efficacy, and rapid recovery. The surgical incision is only 8 mm, and typically only one stitch is needed post-operation. It is currently one of the minimally invasive yet highly effective treatment options for cervical and lumbar spine diseases, causing minimal bodily harm.

Applicable Population for Transforaminal Endoscopic Spine Surgery:

1. Patients with almost all types of disc herniations, particularly large herniations, extruded discs, and those with foraminal stenosis, as well as combined with conditions like osteophyte formation, ligamentum flavum hypertrophy, and lateral recess stenosis.
2. Discogenic low back pain.
3. Patients with postoperative recurrence, surgical scarring, and unclear anatomical structures affecting secondary surgeries.
4. Cauda equina syndrome.
5. Elderly patients who cannot tolerate traditional surgery and anesthesia.

Although transforaminal endoscopic spine surgery has a wide range of applications, it is not suitable for all cervical and lumbar spine disease patients.

Contraindications for Transforaminal Endoscopic Spine Surgery:

1. Lumbar instability with disc herniation.
2. Multisegmental disc herniation.
3. Infection at the puncture site, path, or intervertebral space (excluding post-disc surgery infections or tuberculosis).
4. Cases with spinal deformities.
5. Patients with fractures or tumors.
6. Patients with coagulation disorders.

7. Patients with psychiatric disorders.

8. Patients with severe internal organ dysfunction or other physical conditions that cannot tolerate surgery.

Transforaminal endoscopic spine surgery, as a crucial method in modern minimally invasive spinal surgery, is increasingly gaining attention from both the medical community and patients. Its efficiency and safety have brought significant benefits to many patients with cervical and lumbar spine diseases, improving their quality of life. With continuous advancements and refinements in technology, transforaminal endoscopic spine surgery is expected to play an important role in an even broader range of fields.

For patients, choosing the most suitable treatment method is crucial. Under the guidance of a professional physician, evaluating the pros and cons of various treatment options based on individual disease characteristics is essential for achieving the best treatment outcomes. With ongoing innovations in medical technology and improvements in the healthcare system, transforaminal endoscopic spine surgery will offer hope for recovery to more patients and open up broader prospects for the treatment of spinal diseases.

*Surgery, in addition to the appropriate chemotherapy and radiotherapy, are effective in treating early cancer, but certain patients in late stage of cancer may not be tolerate surgery well as they can be relatively weak. A combination of carefully planned minimally invasive therapy, chemotherapy or radiotherapy can effectively reduce the side effects and discomfort of treatment and may help patient get better efficacy.