Endoscopic Spinal Hernia Surgery (TESSYS) helps relieve your pain quickly

Spinal hernias can be removed using different types of surgical methods. Over the years, the techniques used to remove this type of hernias have been vastly improved, and the same can be said about the medical equipment used in these procedures. TESSYS (transforaminal endoscopic surgical system) is currently the fastest and most effective surgical technique to help you put an end to your pain. In most cases, you regain mobility two hours after surgery and are able to go home pain free.

Iprenburg Spine Clinic is an independent treatment centre (known as Zelfstandige Behandelcentra or ZBC). We are the only orthopedic clinic in The Netherlands that specialises in TESSYS surgical techniques. Due to our high degree of specialisation and extensive experience, we can provide patient-centered, fast, and efficient care.

In this page you will find answers to the following questions:

• Can you briefly explain what is TESSYS spinal surgery?
• What does TESSYS stand for?
• Can all spinal hernias be removed using endoscopic surgery?
• Can TESSYS be used to treat more than one spinal hernia at the time?
• Can double hernias be removed using TESSYS?
• Is the risk of recurrence higher with this type of surgery?
• Which pain relief methods are available?
• What are the advantages of the TESSYS technique?
• What are the disadvantages of the TESSYS technique?

Can you briefly explain what is TESSYS spinal surgery?

TESSYS is a medical term that has been in use since this technology was first developed in the Netherlands in 2004. At the time, this technique was called “endoscopic disc surgery through the foramen with lateral incision”. TESSYS can be compared to keyhole surgery, since the hernia is removed through a small incision (8 mm long) made in the side of the body. Surgery is performed under local anesthesia (using analgesics and sedatives) and always takes place on an outpatient basis. The procedure takes approximately half an hour. Following surgery, you will need to stay in the recovery room for about two hours, and you will be able to go home shortly afterwards if recovery is uneventful. In addition to being faster, the endoscopic procedure also has the advantage of having a minimal risk of complications. Moreover, the surgical incision will heal into a small scar. Another great advantage of this technique is that you can go back to work much faster. In short, the operation is minimally invasive. In recent years, this surgical technique has become known as TESSYS among the international medical community.

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What does TESSYS stand for?

TESSYS stands for Transforaminal Endoscopic Surgical SYStem:

• Transforminal means “through the foramen”. The foramen is the opening that exists between two vertebrae on the side of the spinal canal, where spinal nerves run through.
• Endoscopic means “with the help of an endoscope”. An endoscope is an instrument that consists of a video camera and a flexible shaft that is approximately 3.7 mm in diameter. The shaft is inserted into the body, usually with the help of a forceps. Thanks to the endoscope, surgeons are able to reach the spinal canal and examine spinal hernias.

Can all spinal hernias be removed using endoscopic surgery?

At Iprenburg Spine Clinic we are able to remove virtually every type of spinal hernia. We can also treat primary hernias, relapses, and foraminal hernias using the TESSYS technique. To be able to give you personalised advice, we ask that you complete our diagnosis form and send us a copy of a recent MRI of your lower back. The MRI should not be older than six months. Whenever possible, we ask you to send us a recent MRI report too.

Can double hernias be removed using the TESSYS technique?

Yes, we can also remove double hernias using this surgical technique, including spinal hernias that extend from the left to the right side of the body.

Can TESSYS be used to treat more than one spinal hernia at the time?

The majority of patients have a single spinal hernia, but multiple hernias do exist. Whenever necessary, at Iprenburg Spine Clinic we can treat multiple hernias in a single surgical procedure. Of course, in these cases surgery may take twice as long.

Is the risk of recurrence higher with this type of surgery?

The table below is the result of extensive scientific research on this topic. This shows that six years after surgery, the risk of recurrence of a spinal hernia is smaller in patients who were treated using TESSYS than in patients who were treated using conventional techniques (8.4% for TESSYS patients vs 13.5% for all other patients).

The five surgical operation techniques that were evaluated for the purposes of this study are vertebral fixation (or vertebral fusion), laminectomy, open discectomy (used in 68.9% of all cases studied), endoscopic discectomy (16.1%), and nucleolysis. The surgical method used made no difference to the percentage of patients who experienced recurrence. The total number of patients selected for this study was 18,590.

5  Surgical methods ( fusion, laminectomy, open discectomy 68.9%, endoscopic discectomy 16.1% and nucleolysis.
Reoperation rate after: (n = 18.590)

Time indication	Percentage
3 months	5,4%
1 year	7,4%
5 years	13,5%

Iprenburg Spine Clinic – Guest Speaker BASS

Time indication	Percentage
1-6 years	8,4%

Bron: Spine Volume 38. Number 7. April, 2013

Which pain relief methods are available?

One of the main advantages of the TESSYS technique performed at Iprenburg Spine Clinic is that surgery takes place under local anesthesia, so no epidural injections are needed. During surgery, our anesthesiologist will ensure that you are as comfortable as possible. To achieve this, you will be given a sedative (pill or intravenous) prior to surgery. We understand that every patient is different, so we can provide additional pain relief using analgesics or sedatives if necessary. This anesthetic method makes the procedure extremely safe, and most patients tell us that the procedure was less painful than expected. In fact, they say that going to the dentist is much worse!

Another benefit of this method is that it eliminates the risks involved in putting a patient under general or epidural anesthesia. Moreover, the risk of damage to a nerve is very small. You will be conscious during surgery and your legs will not be numb. This means that you will be able to you feel when the surgeon gets close to major nerves. Perhaps this sounds unsettling, but rest assured that our choice of anesthetic has been chosen with the utmost regard for our patients’ safety. If you prefer it, we can put you to sleep during surgery, always making sure that you can be easily awoken.

What are the main advantages of having an endoscopic procedure at Iprenburg Spine Clinic?

• Our short waiting list means that surgery can be promptly arranged. Once you complete our patient assessment form, you will only have to wait for a maximum of 1 to 2 weeks before having a consultation. If the consultation shows that you can benefit from surgery, we can set a date for the procedure there and then, usually 1 to 2 weeks later. We can expedite the procedure for patients who are affected by paresis (partial paralysis).
• Spinal hernia surgery and recovery are fast. Typically, you regain mobility two hours after surgery and can move without feeling any pain in your legs or feet. You will be able to go home shortly after surgery.
• Because the surgical incision is only 8 mm long, there is little to no scarring.
• The stability of the spine is not affected and the most important stabilising muscle of the back (the multifidus muscle) remains intact.
• Iprenburg Spine Clinic performs endoscopic disc surgery under local anesthesia. Additional pain relief (analgesics or sedatives) is also available.
• The procedure is particularly suitable for patients who have already had spinal hernia surgery and who experienced recurrence.
• Narrowing of the foramen (foraminal stenosis) and narrowing of the spinal canal (spinal stenosis) can also be treated with endoscopic surgery.
• The procedure can be also performed on heavy patients.
• The risk of complications is minimal.

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What are the disadvantages of the TESSYS technique?

• Some patients are not too comfortable with the idea of being under local anesthesia. This type of surgery requires the patient to be able to indicate when the surgeon comes too close to a nerve. Of course, we always ensure that the level of pain relief provided is adequate to the needs of each patient.
• The procedure is relatively costly due to the type of equipment and instruments needed (disposable). We only use surgical instruments once.
• • The surgery is not reimbursed by insurers, despite the fact that this procedure has been internationally recognised as standard practice. Complaints about insurance companies failing to reimburse this procedure have reached the National Ombudsman and the Amsterdam Court of Appeal (December 2012).

There are other surgical techniques available to patients who need their spinal hernia removed. In most cases, your GP will be able to explain the advantages and disadvantages of each and help you make a suitable choice. If your doctor does not have enough knowledge about the TESSYS technique, you can refer him or her to the video “TESSYS (PTED in The Netherlands) Technique Step by Step”. This video is available from our clinic. Of course, your doctor can always contact us directly to discuss any issues with Dr. Iprenburg.

Auteur:Menno Iprenburg

Determining If You Are Eligible For TESSYS Endoscopic Hernia Surgery

To qualify for an endoscopic spinal hernia procedure at Iprenburg Spine Clinic you will need to meet the following criteria:

1. You have a spinal hernia. Iprenburg Spine Clinic does not treat cervical hernias.
2. You are in possession of a recent copy of an MRI scan (not older than six months). Iprenburg Spine Clinic can also perform an MRI upon request. The scan and subsequent evaluation can be arranged at short notice.
3. You have filled out our diagnosis form.
4. We will provide a preliminary diagnosis based on the information you have given us. We will then contact you to discuss the treatment options available.

In most cases we can provide a quick preliminary diagnosis and give you treatment advice based on your patient assessment form and on your latest MRI report. We can also assess whether you can benefit from having spinal hernia surgery at our clinic. We offer treatment advice completely free of charge.

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