Percutaneous full endoscopic lumbar discectomy for adjacent segment disease after lumbar fusion in elderly patients

Purpose: The aim of the study was to evaluate the short-term efficacy and safety of percutaneous full endoscopic lumbar discectomy（PELD）in the treatment of adjacent segment disease（ASD）after lumbar fusion in elderly patients. Methods: Between October 2017 and January 2020, 32 patients with symptomatic ASD were accepted the PELD. All patients used the transforaminal approach and recorded the operation time and intraoperative conditions. Preoperative, 3, 12, 24 months of postoperative and at the last follow-up, the pain of back and leg of visual analog scale (VAS), Oswestry dysfunction index (ODI) and Japanese Orthopedic Association Assessment Treatment Score (JOA) were performed, and the clinical efficacy was evaluated according to MacNab standards. The lumbar MRI was performed to evaluate the decompression of the nerve roots, and the lumbar lateral and dynamic X-rays were performed to evaluate the stability of the surgical segment. Results: 32 patients were included in the study, including 17 males and 15 females. The follow-up time ranged from 24 to 50 months, with an average of (33.2±8.1) months and an average operation time of (62.7±28.1) minutes. Compared with preoperatively, the VAS score of the back and leg pain (P<0.05), ODI (P<0.05) and JOA (P<0.05) of postoperative were significantly improved. At the last follow-up, according to the modified MacNab standard assessment, 24 cases were excellent, 5 cases were good, and 3 cases were fair, the excellent and good rate was 90.65%. As for complications, 1 case had a small rupture of the dural sac during the operation, which was found but not repaired during the operation, and 1 case recurred after the operation. At the last follow-up, 3 cases of intervertebral instability. Conclusion: PELD showed satisfactory short-term efficacy and safety in the management of ASD after lumbar fusion in elderly patients. Therefore, PELD might be an alternative choice for elderly patients with symptomatic ASD after lumbar fusion, but surgical indications must be strictly controlled.