Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, Shandong Province, 266003, People's Republic of China.
Department of Intensive Care Unit, Qilu Hospital of Shandong University (Qingdao), 758 Hefei Road, Qingdao, Shandong Province, 266035, People's Republic of China.
BMC Surg. 2024 Jun 7;24(1):177. doi: 10.1186/s12893-024-02470-8.
OBJECTIVE: The objective of this study is to evaluate and compare the surgical outcomes and complications of Percutaneous Endoscopic Lumbar Decompression (PELD) and traditional revision surgery in treating symptomatic Adjacent Segment Degeneration (ASD). This comparison aims to delineate the advantages and disadvantages of these methods, assisting spine surgeons in making informed surgical decisions. METHODS: 66 patients with symptomatic ASD who failed conservative treatment for more than 1 month and received repeated lumbar surgery were retrospectively collected in the study from January 2015 to November 2018, with the average age of 65.86 ± 11.04 years old. According to the type of surgery they received, all the patients were divided in 2 groups, including 32 patients replaced the prior rod in Group A and 34 patients received PELD at the adjacent level in Group B. Patients were followed up routinely and received clinical and radiological evaluation at 3, 6, 12 months and yearly postoperatively. Complications and hospital costs were recorded through chart reviews. RESULTS: The majority of patients experienced positive surgical outcomes. However, three cases encountered complications. Notably, Group B patients demonstrated superior pain relief and improved postoperative functional scores throughout the follow-up period, alongside reduced hospital costs (P < 0.05). Additionally, significant reductions in average operative time, blood loss, and hospital stay were observed in Group B (P < 0.05). Notwithstanding these benefits, three patients in Group B experienced disc re-herniation and underwent subsequent revision surgeries. CONCLUSIONS: While PELD offers several advantages over traditional revision surgery, such as reduced operative time, blood loss, and hospital stay, it also presents a higher likelihood of requiring subsequent revision surgeries. Future studies involving a larger cohort and extended follow-up periods are essential to fully assess the relative benefits and drawbacks of these surgical approaches for ASD.
目的：本研究旨在评估和比较经皮内镜腰椎减压术（PELD）与传统翻修手术治疗症状性邻近节段退变（ASD）的手术结果和并发症。比较目的在于阐明这些方法的优缺点，帮助脊柱外科医生做出明智的手术决策。
方法：回顾性收集 2015 年 1 月至 2018 年 11 月间因保守治疗超过 1 个月且接受过多次腰椎手术的 66 例症状性 ASD 患者，平均年龄 65.86±11.04 岁。根据手术类型，所有患者分为 2 组，A 组 32 例更换原棒，B 组 34 例在相邻水平行 PELD。患者常规随访，术后 3、6、12 个月及每年进行临床和影像学评估。通过病历回顾记录并发症和住院费用。
结果：大多数患者的手术结果为阳性。然而，有 3 例出现并发症。值得注意的是，B 组患者在整个随访期间疼痛缓解和术后功能评分改善更为显著，同时住院费用降低（P<0.05）。此外，B 组患者的平均手术时间、出血量和住院时间均显著减少（P<0.05）。尽管有这些益处，但 B 组有 3 例患者出现椎间盘再突出，需要进行后续翻修手术。
结论：虽然 PELD 比传统翻修手术具有减少手术时间、出血量和住院时间等优势，但也增加了需要后续翻修手术的可能性。未来需要更大样本量和更长随访期的研究来全面评估这些 ASD 手术方法的相对优缺点。
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