Percutaneous Transforaminal Endoscopic Discectomy for Adjacent Segment Disease versus Lumbar Disc Herniation in Elderly Patients

Figures & data

Table 1 Demographic Characteristics of Enrolled Patients

Parameters	ASD	Non-ASD	p
Age (year)	70.38±10.43	66.59±8.73	0.086
BMI (kg/m²)	26.70±3.85	25.76±4.49	0.325
Gender (M/F)
Male	17(43.59%)	19(48.72%)	0.820
Female	22(56.41%)	20(51.28%)
Levels of previous fusion
L1-L3	1(2.56%)	–
L3-L5	33(84.62%)	–
L5-S1	5(12.82%)	–
Surgical level
L1-L2	1(2.56%)	0	0.774
L2-L3	2(5.13%)	3(7.69%)
L3-L4	6(15.38%)	6(15.38%)
L4-L5	14(35.90%)	11(28.21%)
L5-S1	16(41.03%)	19(48.72%)
Operation time (min)	118.21±21.87	99.23±22.87	<0.001
Intraoperative blood loss (mL)	12.95±6.56	11.28±4.96	0.336
Hospital time (day)	12.43±5.50	9.82±3.92	0.048

Notes: Statistically significant p -values are highlighted in bold.

Abbreviations: BMI, Body Mass Index; ASD, adjacent segment disease.

Table 2 Comparison of Scores Between Two Groups

	ASD	Non-ASD	p
VAS-BP
Pre-operation	4.41±0.75	4.1±0.45	0.012
Post-operation	2.95±1.15	2.79±1.00	0.464
12-months post	2.72±0.94	2.62±1.11	0.803
24-months post	2.41±1.31	2.36±1.31	0.864
Last follow-up	2.46±1.29	2.41±1.33	0.857
VAS-LP
Pre-operation	6.26±0.85	6.05±0.89	0.470
Post-operation	2.28±1.34	2.03±1.25	0.654
12-months post	2.33±1.61	2.00±1.28	0.457
24-months post	2.23±1.39	1.97±1.14	0.432
Last follow-up	2.05±1.36	1.97±1.06	1.000
ODI
Pre-operation	68.23±8.11	68.38±6.36	0.946
Post-operation	25.46±9.46	26.21±5.76	0.127
12-months post	23.95±9.70	23.51±5.08	0.693
24-months post	23.44±9.51	23.46±5.51	0.434
Last follow-up	23.64±9.00	22.62±5.07	0.979
MacNab
Excellent	20(51.28%)	22(56.41%)	0.629
Good	14(35.90%)	13(33.33%)
Fair	4(10.26%)	2(5.13%)
Poor	1(2.56%)	2(5.13%)
Complications	2(5.13%)	1(2.56%)	0.562
Severe complications	0	0
Follow-up time (month)	41.23±17.08	38.2±14.64	0.402

Notes: Statistically significant p -values are highlighted in bold.

Abbreviations: VAS-LP, visual analog scale for leg pain; VAS-BP, visual analog scale for back pain; ODI, Oswestry dysfunction index; MacNab, MacNab criteria; ASD, adjacent segment disease.

Figure 1 Postoperative scores of VAS-BP, VAS-LP and ODI significantly improved in both groups. p-value<0.001 in comparison between preoperative and all postoperative valued scores.

Abbreviation: VAS-LP, visual analog scale for leg pain; VAS-BP, visual analog scale for back pain; ODI, Oswestry dysfunction index; ASD, adjacent segment disease.

Figure 2 A 71-year-old man with ASD accepted PTED for L5-S1 disc herniation. (A) Preoperative anterior and lateral X-rays showing the L3-L5 having undergone PLIF surgery previously (B) Preoperative CT and MRI showing herniation of the intervertebral disc in the right of adjacent segment L5-S1 (yellow arrow) (C) Postoperative anterior and lateral X-rays showing the L5-S1 having undergone PTED (D) Postoperative CT and MRI showing the herniated intervertebral disc in the right side of L5-S1 having been removed (yellow arrow).

Figure 3 Intraoperative fluoroscopy shows the placement of the protective sleeve; Screenshot of Intraoperative endoscope shows the S1 nerve root after decompression. (1) ligamentum flavum; (2) S1 nerve; (3) intervertebral disc.