Surgical Outcomes of Two Portal Percutaneous Endoscopic Decompression for Adjacent Segment Disease Preliminary Case Series of 21 Patients

Abstract

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