Revision Strategy of Symptomatic Lumbar Adjacent Segment Degeneration: Full Endoscopic Decompression versus Extended Posterior Interbody Fusion

Abstract

We evaluated the clinical and imaging outcomes of full endoscopic lumbar decompression (FELD) compared with extended posterior lumbar interbody fusion (PLIF) for adjacent segment degeneration (ASD) after fusion surgery and developed a revision strategy. The present retrospective study enrolled 65 patients with ASD who had undergone FELD (n= 31) or extended PLIF (n= 34) from January 2014 to January 2018. Clinical evaluations had been performed preoperatively and at 3, 12, and 24 months postoperatively and included the Oswestry disability index, Japanese Orthopaedic Association score for function assessment, and visual analog scale scores for pain. Imaging evaluations were performed preoperatively, immediately after surgery, and at the last follow-up examination. No significant differences were found in the baseline data between the FELD and PLIF groups (P > 0.05), except for the proportion of patients with radiographic adjacent segment instability (P < 0.05). The mean operative time, blood loss, and length of hospital stay were significantly decreased for the FELD group (P < 0.001). For patients with stable ASD, no significant differences were found in the clinical outcome between the 2 groups (P > 0.05). The PLIF group had significantly restored disc height after surgery (P < 0.05). For patients with unstable ASD, the low back and leg pain of the PLIF group were more significantly relieved compared with the FELD group within 3-24 months postoperatively (P < 0.05). The function of the PLIF group had significantly improved within 12 months postoperatively (P < 0.05). The use of FELD achieved satisfactory outcomes for the treatment of radiographic stable ASD, which were not worse than those with PLIF. With less trauma and faster recovery, FELD could be an alternative option.