Percutaneous endoscopical transforaminal approach versus PLF to treat the single-level adjacent segment disease after PLF/PLIF: 1–2 years follow-up

BACKGROUND: Adjacent segment disease (ASD) is a common complication after lumbar decompression and fusion surgery. Traditional revision-surgery, including posterior lumbar decompression and posterolateral fusion (PLF) or interbody fusion (PLIF) is traumatic. The percutaneous endoscopic transforaminal procedure (PE-TF) has been widely used in patients with lumbar disc disease. However, there are no reports about using PE-TF procedure to treat ASD in the current literature. OBJECTIVE: To compare the clinical outcomes between PE-TF and PLF for single-level ASD after PLF or PLIF. STUDY DESIGN: A retrospective study. SETTING: Department of Spine Surgery. METHODS: There were 64 patients diagnosed with single-level ASD and accepted revision surgery. 33 patients accepted PE-TF (Group A) and 31 underwent PLF (Group B). Oswestry Disability Index (ODI) and Japanese Orthopedic Association (JOA) scores were used to evaluate clinical outcomes. Complications, length of skin incision, hospitalization time and blood loss were investigated according to patient records. RESULTS: All symptoms had improved at the final follow-up. The improvement rate was 82.75% in group A and 86.28% in group B. The satisfactory clinical outcomes were similar in both groups with no recurrence in all cases. PE-TF procedure had significant advantages in the following items: traumatization, cosmetology, hospitalization time and blood loss. CONCLUSIONS: Clinical outcomes of using PE-TF procedure to treat single-level ASD were similar to those of PLF approach, but PE-TF was less invasive and could shorten hospitalization time.