Percutaneous Full Endoscopic Lumbar Discectomy for Symptomatic Adjacent Segment Disease after Lumbar Fusion in Elderly Patients

Abstract

Purpose Treatment of adjacent segment disease (ASD) is still controversial. The aim of this study was to evaluate the short‐term efficacy and safety and to analyze the technical advantages, surgical approach, and indications of percutaneous full endoscopic lumbar discectomy (PELD) in the treatment of ASD after lumbar fusion in elderly patients. Methods A retrospective of 32 patients with symptomatic ASD were accepted for PELD from October 2017 to January 2020. All patients used the transforaminal approach and recorded the operation time and intraoperative conditions. Preoperative, 3, 12, 24 months of postoperative and at the last follow‐up, the pain of back and leg of visual analog scale (VAS), Oswestry dysfunction index (ODI), and Japanese Orthopaedic Association Assessment Treatment Score (JOA) were performed, and the paired student's t test was used to the compare the continuous variables preoperatively and postoperatively. The clinical efficacy was evaluated according to MacNab standards. The lumbar MRI was performed to evaluate the decompression of the nerve roots, and the lumbar lateral and dynamic X‐rays were performed to evaluate the stability of the surgical segment. Results A total of 32 patients were included in the study, including 17 males and 15 females. The follow‐up time ranged from 24 to 50 months, with an average of (33.2 ± 8.1) months and an average operation time of (62.7 ± 28.1) minutes. Compared to preoperatively, the VAS score of the back and leg pain (p < 0.05), ODI (p < 0.05), and JOA (p < 0.05) postoperatively were significantly improved. At the last follow‐up, according to the modified MacNab standard assessment, 24 cases were excellent, five cases were good, and three cases were fair, the excellent and good rate was 90.65%. As for complications, one case had a small rupture of the dural sac during the operation, which was found but not repaired during the operation, and one case recurred after the operation. At the last follow‐up, there were three cases of intervertebral instability. Conclusion PELD showed satisfactory short‐term efficacy and safety in the management of ASD after lumbar fusion in elderly patients. Therefore, PELD might be an alternative choice for elderly patients with symptomatic ASD after lumbar fusion, but surgical indications must be strictly controlled.

Percutaneous Transforaminal Endoscopic Discectomy for Adjacent Segment Disease versus Lumbar Disc Herniation in Elderly Patients

“…Of the patients with ASD, 87.15% (34/39) showed excellent and good clinical outcomes at final follow-up, which is akin to the rate of 90.63% (29/32) in the study of Feng and others. 16 All measured indexes exhibited statistically significant improvements in all follow-up sections compared to preoperative scores. Previous research has explored the application of variable treatment for ASD following lumbar fusion.…”

Correlation between Disc Imaging Observations and Clinical Efficacy after Percutaneous Endoscopic Lumbar Discectomy: A 1‐Year Follow‐up Study

“…PELD treats almost all types of LDH. 28 , 29 , 30 , 31 The authors Dewin and others found that among a younger group of patients, the outlook for patients who underwent surgery for occult or herniated lumbar disc herniation was significantly better than for those with contained lumbar disc herniation. 32 However, the criteria for classification in their research were not concrete enough.…”