(I-683) Reoperation Rates and Outcomes After Surgical Treatment of Lumbar Adjacent Segment Disease: a Comparison of Extension of Fusion, Minimally Invasive Decompression, and Endoscopic Decompression.
Medical Student University of Miami Miller School of Medicine Miami, Florida, United States
Introduction: Adjacent-segment disease (ASD) is a complication following thoracolumbar instrumented fusions. Various surgical options are available to address ASD – endoscopic decompression, minimally invasive decompression, or extension of fusion. However, the optimal treatment strategy for symptomatic ASD has not been established. We aim to characterize the re-operation rates and clinical outcomes after surgical management of ASD in a single-surgeon series.
Methods: A retrospective review was performed on a consecutive series of patients undergoing revision surgery for thoracolumbar ASD by the senior author (MW) between October 2011 to February 2022. Patients were treated with endoscopic decompression, MIS decompression, or extension of fusion. The primary outcome was reoperation rates between treatment strategies. Secondary outcomes included: time to reoperation, improvement in back and leg pain, estimated blood loss, and length of stay.
Results: Sixty-six of 134 patients undergoing surgery for symptomatic ASD met inclusion criteria. Re-operation rates after ASD treatment were higher in patients who underwent endoscopic decompression/discectomy (53%) and microdiscectomy (50%) compared to extension of fusion procedures (20%) (p=0.025, Table 1). The mean length of time to reoperation was 7.0 months, 10.4 months, and 22.8 months, respectively. There was significant improvement in 10- and 24-week post-operative back pain (p=0.0432 and 0.0426, respectively) and 24-week leg pain (p= 0.0390) with extension of fusion compared to the decompression only cohorts (Figure 1A and B). Estimated blood loss and length of stay was highest in the extension of fusion group.
Conclusion : Reoperation after surgical treatment of ASD is common. Extension of fusion was most protective against reoperation compared to minimally invasive and endoscopic decompression techniques. Furthermore, extension of fusion most durably improved leg and back pain scores.
