Abstract
Purpose. Adjacent segment disease (ASD) is a complication following lumbar spine decompression and fusion surgery. Whether it is a new degenerative process or iatrogenic from biomechanically altering motion segments that create additional foreign stressors. There are two problems in ASD that may not come together, new compression segment adjacent to previous operative level or spinal instability following previous operation. Appropriate treatment is spinal decompression alone or spinal decompression and fusion. There are only few reports on endoscopic surgery for ASD. This study aimed to show surgical outcomes of two portal percutaneous endoscopic decompression without fusion for ASD. Methods . Twenty one patients who underwent two portal percutaneous endoscopic decompression for ASD were retrospectively investigated (follow-up at least two years). Operative complications, VAS-back pain, VAS-leg pain, ODI and Macnab criteria were used as outcome measures. Results. Mean VAS- leg pain improved from 7.9 + 2.1 just before operation to 1.9 + 1.1 at two years follow-up (p < 0.05). VAS- back pain improved from 3.5 + 2.2 before operation to 2.9 + 1.4 at two years follow up difference was statistically insignificant. The ODI score was improved from 63.2 + 10.7 to 24.0 + 14.5) (P < 0.05) at two years follow up. One patient was converted to open decompression due to intraoperative endoscopic difficulty. One patient underwent pedicle screws fixation and fusion after percutaneous endoscopic decompression because of post-operative instability. Conclusion. Two portal percutaneous endoscopic decompression is effective procedure for leg pain relief in ASD. This is a short term results. Long term follow up is required because decompression alone may lead to progressive instability and recurrent symptoms. Keyword; endoscope, decompression, spinal stenosis, adjacent segment degeneration
Highlights
Adjacent segment disease (ASD) is one of the problematic complications following lumbar spine instrumentation and fusion[1]
21 consecutive patients undergoing percutaneous endoscopic decompression for ASD between January 2012 and June 2013 were enrolled in this study
21 consecutive patients were treated with two portal percutaneous endoscopic decompression
Summary
Adjacent segment disease (ASD) is one of the problematic complications following lumbar spine instrumentation and fusion[1]. ASD is the result of the normal progression of degenerative changes or biomechanical alteration caused by fusion remains controversial[2]. The clinical incidence of symptomatic ASD is reportedly 5.2-18.5% 1 and the incidence of re-operation for symptomatic ASD is reported 3.011.0 % of patients after spinal fusion[5,6]. A prospective randomized study reported that fusion accelerates degenerative changes at the adjacent segment of fused spine compared with naturally occurring changes[7]. Spinal fusion changes the biomechanics of spinal motion or the load on facet joints of the adjacent motion segment of the fused spine[1]. Some surgeons reported treatment of patients of ASD
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