A Follow-up Study on the Degeneration of Adjacent Segments After TLIF and Foraminal Endoscopy

Objective: To compare the clinical outcomes of transforaminal lumbar interbody fusion (TLIF) and endoscopic discectomy in the treatment of postoperative adjacent segment degeneration in patients with lumbar disc herniation (LDH). Methods: From 2014 to 2017, 87 patients who were diagnosed with single-levelLDH and received surgery of TLIF (group X, n = 43) or endoscopic discectomy (group F, n = 44) were retrospectively analyzed. X-ray, MRI, CT and clinical symptoms were recorded before operation and at the last follow-up. The neurological function was originally evaluated by the Japanese Orthopaedic Association (JOA) score. Radiological evaluation included the height of intervertebral space (HIS), intervertebral foramen height (FH), intervertebral foramen area (FA), lumbar lordosis (CA) and intervertebral disc degeneration Pfirrmann score. Results: There was no significant difference in average operation age, JOA improvement rate, reoperation rate and complications between the two groups. The average blood loss, average hospital stays and average operation time in group F were lower than those in group X. During the last follow-up, HIS, CA and FA decreased in both groups, and the changes in group X were more significant than those in group F (P < 0.05). There was no significant difference in postoperative FH between the two groups, but it decreased more in group X (P < 0.05). Conclusion: Both TLIF and endoscopic surgery can achieve good results in the treatment of LDH, but the risk of lumbar adjacent segment degeneration after intervertebral foraminal surgery is lower.