Targeted one channel percutaneous transforaminal endoscopic discectomy for the treatment of adjacent segment degeneration after spinal fusion surgery in young patients

Abstract

To compare clinical efficacy between targeted one-channel percutaneous transforaminal endoscopic discectomy (TO-PTED) and transforaminal lumbar interbody fusion (TLIF) in treatment of adjacent segment degeneration (ASD) after spinal fusion surgery in young patients. The clinical data of 64 patients with adjacent segment degeneration after spinal fusion fusion surgery from September 2017 to February 2019 were retrospectively analyzed. Among them, 30 patients were treated with TO-PTED (TO-PTED group), there were 19 males and 11 females, aged from 23 to 34 years, with a mean of(31.20±1.67) years;the course of disease was from 10 to 39 months, with a mean of (26.30±0.41) months. And other 34 patients were treated with TILF(TILF group), there were 21 males and 13 females, aged from 22 to 34 years, with a mean of (31.10±1.74) years;the course of disease was from 11 to 40 months, with a mean of (27.10±0.32) months. The operation time, intraoperative blood loss, hospitalization time, X-ray fluoroscopy times were compared between two groups. Visual analogue scale(VAS) and Japanese Orthopaedic Association(JOA) scores were used to evaluate the clinical efficacy between two groups before operation, 1 month after operation and at the final follow-up. Operation time, intraoperative blood loss, hospitalization time, X-ray fluoroscopy times were (76.30±5.08) min, (38.80±4.21) ml, (3.90±1.13) d, (8.80±2.53) times in TO-PTED group, and (118.50±11.06) min, (162.71±19.31)ml, (7.30±1.42)d, (4.10±0.82) times in TLIF group, respectively, the difference between the two groups was statistically significant. All patients were followed up from 12 to 24 months, with a mean of (18.00±5.63) months. VAS and JOA scores at 1 month after surgery and at final follow-up were obviously improved, and TO-PTED group was superior than TLIF group. Both TO-PTED and TLIF can achieve good results in the treatment of adjacent segment degeneration after spinal fusion surgery in young patients. TO-PTED has advantages in reducing operation time, intraoperative blood loss and postoperative recovery time, but it will increase the number of patients receiving intraoperative radiation.