Managing lumbar adjacent segment disease: A description of minimally invasive techniques and algorithm

Area of Science:

• Spine Surgery
• Minimally Invasive Techniques
• Adjacent Segment Disease Management

Background:

• Adjacent segment disease (ASD) is a complication following spinal fusion.
• Effective management strategies for symptomatic lumbar ASD are crucial.
• Minimally invasive surgical techniques offer potential benefits for ASD treatment.

Purpose of the Study:

• To present a tailored, step-by-step guide for managing lumbar ASD using minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).
• To outline four distinct surgical approaches for MIS-TLIF in patients with prior spinal fusion.
• To provide insights into an algorithmic approach for lumbar ASD management.

Main Methods:

• Retrospective study of 23 patients with lumbar ASD treated between January 2008 and December 2023.
• Application of four tailored MIS-TLIF techniques based on patient-specific factors.
• Evaluation of clinical outcomes using Oswestry Disability Index (ODI) and Visual Analog Scale (VAS).

Main Results:

• All 23 patients (age 40-80 years) showed significant clinical improvement without conversion to open surgery.
• Mean ODI decreased from 58.47 to 22.58.
• Mean VAS scores improved from 7.076 to 1.9.

Conclusions:

• The study demonstrates the efficacy of an algorithmic, posterior MIS-TLIF approach for lumbar ASD.
• Minimally invasive techniques provide significant clinical benefits for patients with adjacent segment disease.
• This approach offers valuable insights for surgeons managing complex spinal conditions.