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Incidence of postoperative progressive segment degeneration at decompression and adjacent segments after minimally invasive lumbar decompression surgery: a 5-year follow-up study.

OBJECTIVE
There are several reported studies on the incidence of adjacent segment disease (ASD) after lumbar fusion surgery; however, the incidence of ASD after decompression surgery has not been well studied. In this study the authors aimed to investigate the incidence of progressive segment degeneration (PSD) at the decompression and adjacent segments 5 years after minimally invasive lumbar decompression surgery.


METHODS
We investigated data from 168 patients (mean age, 69.5 ± 9.2 years) who underwent bilateral microscopic or microendoscopic decompression surgery via a unilateral approach and were followed up for more than 5 years. Outcomes were self-reported visual analog scale (VAS) scores for low-back pain, leg pain, and leg numbness and physician-assessed Japanese Orthopaedic Association (JOA) scores for back pain. Changes in the disc height and movement of the adjacent lumbar segments were compared using preoperative and 5-year postoperative lateral full-length standing whole-spine radiographic images. PSD was defined as loss of disc height > 3 mm and progression of anterior or posterior slippage > 3 mm. The incidence and clinical impact of PSD were investigated.


RESULTS
The mean JOA score improved significantly in all patients from 13.4 points before surgery to 24.1 points at the latest follow-up (mean recovery rate 67.8%). PSD at the decompression site was observed in 43.5% (73/168) of the patients. The proportions of patients with loss of disc height > 3 mm and slippage progression were 16.1% (27/168) and 36.9%, respectively (62/168: 41 anterior and 21 posterior). The proportion of patients with PSD at the adjacent segment was 20.5% (35/168), with 5.4% (9/168) of the patients with loss of disc height > 3 mm and 16.0% (27/168: 13 anterior and 14 posterior) with slippage progression. There was no significant difference in the clinical outcomes between patients with and those without PSD.


CONCLUSIONS
Radiological ASD was observed even in the case of decompression surgery alone. However, there was no correlation with symptom deterioration, measured by the VAS and JOA scores.