J Korean Soc Spine Surg.  2017 Dec;24(4):221-230. 10.4184/jkss.2017.24.4.221.

Clinical Outcomes of Percutaneous Endoscopic Lumbar Discectomy for Adjacent Lumbar Disc Herniation after Lumbar Posterolateral Fusion by Radiologic Evaluations

• Ko YC
• Ha DJ
• Park MJ
• Huh JW
• Park SH
• Park TH
• Park JH

• KMID: 2408190
• DOI: http://doi.org/10.4184/jkss.2017.24.4.221

Abstract

STUDY DESIGN: A retrospective study.
OBJECTIVE
To analyze the effectiveness of percutaneous endoscopic lumbar discectomy (PELD) for adjacent lumbar disc herniation through radiologic evaluations. SUMMARY OF LITERATURE REVIEW: PELD minimizes posterior structural damage, allowing rapid rehabilitation.
SUBJECTS AND METHODS
This study was conducted on 45 patients who were followed up for 1 year after PELD for adjacent lumbar disc herniation from March 2014 to February 2016. The modified Macnab criteria, the modified Suezawa and Schreiber score (MSS score), and visual analogue scales for the back (VAS-B) and legs (VAS-L) were evaluated. The disc height ratio and segmental angulation change were compared before posterolateral fusion and before PELD. Moreover, spinal stenosis was confirmed on magnetic resonance imaging (MRI) before PELD.
RESULTS
Based on the modified Macnab criteria, 53.3% patients received an evaluation of at least "good," and the mean MSS score improved from 4.77 to 6.99 at 1 year after the operation. The mean VAS-B score decreased from 7.02 to 4.67, and the mean VAS-L score decreased from 8.15 to 4.24 at 1 year after the operation. The mean disc height ratio was 87.1%, and the mean segmental angulation change was 6.5°, with a greater change in the "fair" or "poor" group, and the rate of spinal stenosis on MRI was also higher in the "fair" or "poor" group.
CONCLUSION
The clinical outcomes of PELD, which is accompanied by degenerative changes on simple radiographic images such as disc space narrowing and increased segmental angulation or spinal stenosis on MRI, may not be satisfactory. Therefore, decisions regarding surgery should be made carefully in such cases.

Keyword

Lumbar posterolateral fusion; Adjacent segment disease; Adjacent lumbar disc herniation; Percutaneous endoscopic lumbar discectomy; Radiologic evaluation

MeSH Terms

Diskectomy*
Humans
Leg
Magnetic Resonance Imaging
Rehabilitation
Retrospective Studies
Spinal Stenosis
Weights and Measures

Figure

• 

  Fig. 1. Mochida method for measuring the disc height ratio. Radiographic measurement of the disc height ratio: a/A (at the final follow-up)×[a/A (before the operation)], a=disc height, A=vertebral height.

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  Fig. 2. Measuring the segmental angulation. The angle between the line on the lower endplate of the upper vertebra and the line on the upper endplate of the lower vertebra is measured on flexion and extension radiographs. In addition, the difference (B-A) is calculated.

• 

  Fig. 3. (A) A 62-year-old female patient with spinal stenosis at L4-5: simple anteroposterior (AP) and lateral radiographs before lumbar posterolateral fusion. (B) Flexion-extension lateral radiographs before lumbar posterolateral fusion. (C) At 63 months postoperatively, simple AP and lateral radiographs before percutaneous endoscopic lumbar discectomy show almost no interval change of L3-4 disc height. (D) Flexion-extension lateral radiographs show an L3-4 segmental angulation change of 5.4°. (E) Left-side central disc herniation of the L3-4 segment without spinal stenosis on magnetic resonance imaging taken before percutaneous endoscopic lumbar discectomy (PELD). (F) The disc material removed after PELD; the patient's prognosis was good.

• 

  Fig. 4. (A) A 71-year-old female patient with spinal stenosis at L4-S1: simple anteroposterior (AP) and lateral radiographs before lumbar posterolateral fusion. (B) Flexion-extension lateral radiographs before lumbar posterolateral fusion. (C) At 78 months postoperatively, simple AP and lateral radiographs before percutaneous endoscopic lumbar discectomy show decreased L3-4 disc height. (D) Flexion-extension lateral radiographs show an L3-4 segmental angulation change of 9.8°. (E) Left-side posterolateral disc herniation of the L3-4 segment with spinal stenosis on magnetic resonance imaging taken before percutaneous endoscopic lumbar discectomy (PELD). (F) Removed disc material after PELD. (G) Recurrent disc herniation in the same region after PELD (dotted line).

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