Early Use of Endoscopic Unilateral Laminectomy Combined With Bilateral Decompression in Patients With Adjacent Segment Disease After Lumbar Fusion

Objectives The purpose of this study was to investigate the safety and clinical effectiveness of endoscopic unilateral laminectomy with bilateral decompression (END-ULBD) in patients with adjacent segment disease (ASD) after lumbar fusion. Methods We conducted a retrospective study and collected data on 9 patients with ASD after lumbar fusion who were hospitalized in our hospital from January 2021 to January 2022. All 9 patients, aged 54 to 77 years, received Endo-ULBD treatment, with an average age of 59.2 ± 3.6 years. The ASD segments are L2/3 segment 1, L3/4 segment 5, and L5/S1 segment 3. The operation time and blood loss were recorded intraoperatively. For analysis, the visual analog scale (VAS), Oswestry Disability Index (ODI), and modified MacNab Lower Extremity Pain Criteria score were recorded at the last follow-up visit. Results The surgery was successful in 9 patients. There was no neurological injury or dural rupture resulting in cerebrospinal fluid leakage. The average operation time was 90.25 ± 118.0 minutes, the average blood loss was 35.3 ± 5.3 mL, and the average hospitalization time was 14.4 ± 2.1 days. The results also showed that ODI and VAS scores decreased significantly 1 week after surgery. All indicators were statistically improved 1 month after surgery ( P < 0.05). There was no statistically significant difference in ODI and VAS scores 1 month and 3 months after surgery. At the final follow-up, according to the modified MacNab criteria, 7 cases had excellent curative effect and 2 cases had good curative effect. Conclusions In clinical practice, we found that Endod-Ulbd can be combined with a single-portal vein endoscopy for ASD patients with bilateral lower limb symptoms after lumbar fusion, providing a new option for patients.