Avoiding Lumbar Fusion with a Small Endoscopic Partial Discectomy: Long Term Follow-up

18th World Congress of NeuroSurgery, WFNS2023, Cape Town, South Africa.

Objectives
Determine if fusion pathway patients could avoid fusion 2) Follow-up on the result for those patients avoiding fusion.

Background: 
This study was done to determine if patients that had lumbar fusion recommended by surgeons could avoid fusion over the long term.

Methods: 

• Our study group of 68 patients all had lumbar fusion recommended by surgeons that were ready to perform the fusion.
• These 68 patients all chose to have a small endoscopic partial discectomy instead. We did a retrospective analysis with email and phone follow-up, 68 patients responded.
• Success was defined as avoiding fusion over the long term, 88%.
• 68 patients – 24 female – 44 male Aged 21 to 89 – Average age 45.25
• Primarily low back pain = 15 % Objective radiculopathy = 85 %
• Average follow up 45.6 months

Results: 
12 patients had further surgery. Of those 8 had fusion (11.8 %) and 4 had laminectomy or decompression. Overall 17.6 % had some form of further surgery. There were no complications and none of these subsequent operations were done within a year after the small endoscopic procedures.

Analysis of the failures showed that they did not have pure disc pathology. They had disc pathology and also significant bone, joint and ligament changes.

Conclusions:
More alternatives to spine fusion have become available in recent years. These include endoscopic procedures that range in size from small to large. The smaller scopes do not allow drilling and therefore are limited to disc removal. This makes patient selection and matching to the correct equipment important.