A case report Unilateral biportal endoscopic revision for adjacent segmental disease: Case presentations and literature review

Abstract

Rationale: Biportal endoscopic revision surgery for adjacent segmental disease (ASD) after lumbar arthrodesis is seldomly reported. Herein, we present 3 cases of ASD with radiculopathy wherein satisfactory results were obtained using unilateral biportal endoscopic (UBE) decompression. Patient concerns: Case 1 was of a 56-year-old male who presented with a chief complaint of Intermittent claudication since 2-year. Case 2 involved a 78-year-old female who was admitted to the hospital with a chief complaint of radiating pain and weakness in the left leg for at least 1 year. Case 3 was a 67-year-old woman who visited our hospital because of radiating leg pain for 5 months. All the cases had a history of L4 to L5 lumbar interbody fusion surgery. Diagnoses: Computed tomography and magnetic resonance imaging showed the spinal epidural lipomatosis at the L3 to L4 level in case 1, the up-migrated lumbar disc herniation at L3 to L4 level in case 2 and unilateral foraminal stenosis at the L5 to S1 level in case 3. Interventions: Under UBE guidance, the ipsilateral approach was used to treat adjacent lumbar stenosis caused by spinal epidural lipomatosis. The contralateral approach was used to remove the up-migrated herniated disc. The paraspinal approach was applied to decompress the foraminal stenosis. Outcomes: Postoperative parameters were improved clinically, and nerve roots were decompressed radiologically. No complications were developed. Lessons: UBE revision surgery showed a favorable clinical and radiological result without complications and may be a safe and effective alternative technique for ASD. Abbreviations: ASD = adjacent segmental disease, CT = computed tomography, LDH = lumbar disc herniation, LF = ligamentum flavum, MRI = magnetic resonance imaging, NIC = neurological intermittent claudication, PLIF = posterior lumbar interbody fusion, RF = radiofrequency, SAP = superior articular process, UBE = unilateral biportal endoscopy, VAS = visual analog scale.