Comparison of novel double-needle puncture technique to the conventional TESSYS technique in percutaneous endoscopic lumbar discectomy: enhanced efficiency and reduced radiation exposure.

BACKGROUND

Percutaneous endoscopic lumbar discectomy (PELD) is an effective minimally invasive treatment for lumbar disc herniation (LDH). Establishing a precise working channel is critical for success but is technically demanding with the conventional transforaminal endoscopic spine system (TESSYS) technique, often requiring multiple fluoroscopic attempts.

OBJECTIVE

This randomized controlled trial aimed to compare the efficacy and safety of a novel double-needle puncture technique against the conventional TESSYS technique for PELD in treating L4-L5 single-segment LDH.

METHODS

Sixty patients were randomly allocated to the double-needle group (n = 30) or the TESSYS group (n = 30). The novel technique utilized a rigid spoon-shaped needle and a flexible pen-tip needle for tandem puncture. Primary outcomes were the number of fluoroscopic shots, puncture time (from needle insertion to target exposure under endoscopy), and total surgery duration. Secondary outcomes included visual analog scale (VAS) scores for back and leg pain preoperatively and at 1 week, 1 month, 6 months, and 1 year postoperatively, Oswestry Disability Index (ODI) scores, and complication rates.

RESULTS

The double-needle group demonstrated significant reductions in puncture time (8.4 ± 4.5 vs. 15.1 ± 7.4 min, P < 0.001), number of fluoroscopic shots (5.8 ± 1.3 vs. 9.6 ± 3.7, P < 0.001), and total surgery time (62.9 ± 24.5 vs. 81.9 ± 33.6 min, P = 0.015). VAS scores for back and leg pain were significantly lower in the double-needle group at 1 week, 1 month, and 6 months postoperatively (P < 0.05), with no significant difference at 1 year. The rate of required foraminoplasty was lower in the double-needle group (13.3% vs. 36.7%). Complication rates were comparable.

CONCLUSION

For L4-L5 LDH, the double-needle puncture technique improves surgical efficiency by reducing operative time and fluoroscopy exposure compared to the conventional TESSYS technique, with associated benefits in early-to-mid-term postoperative pain. It represents a simpler and potentially safer alternative for establishing the working channel in PELD. TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2500096847). Retrospectively Registered on 07-02-2025.