A less invasive treatment by a full-endoscopic spine surgery for adjacent segment disease after lumbar interbody fusion

Hiroki Iwai, Yasushi Oshima, Tomoaki Kitagawa, Hirokazu Inoue, Yuichi Takano, Hirohiko Inanami, Hisashi Koga


Background: Full-endoscopic spine surgery (FESS) is a suitable treatment for lumbar disc herniation (LDH) and foraminal stenosis. This study investigated the usefulness of FESS in treating adjacent segment disease (ASD) after lumbar interbody fusion (LIF).
Methods: Between September 2015 and March 2019, a total of 13 patients with symptomatic ASD after LIF underwent FESS. Discectomy and foraminoplasty using a 3.5-mm diameter high-speed drill were performed for treating LDH and foraminal stenosis. Preoperative and postoperative statuses were evaluated using Numerical Rating Scale (NRS) and the modified Japanese Orthopedic Association (mJOA) scores.
Results: The patients’ mean age was 64.8 years; there were 10 male and 3 female patients. The mean operative time was 52.7 min. The mean pre- and postoperative NRS scores were 7.6 and 3.1, respectively. The mean pre- and postoperative mJOA scores were 10.5 and 16.1, respectively, and the mean recovery rate was 32.8%. Subsequent operative treatments were required in 3 patients for postoperative complication, insufficient decompression, and recurrence LDH.
Conclusions: FESS is a safe and effective minimally invasive treatment for ASD after LIF and a potential alternative to extend the LIF to the adjacent vertebra or sacrum.

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