Abstract
Background Revision lumbar spine surgery via a posterior approach is more challenging than primary
surgery because of epidural or perineural scar tissue. It demands more extensive removal
of the posterior structures to confirm intact bony landmarks and could cause iatrogenic
instability; therefore, fusion surgery is often added. However, adjacent segment disease
after fusion surgery could be a problem, and further exposure of the posterior muscles
could result in multiple operated back syndrome. To address these problems, we now
perform transforaminal full-endoscopic spine surgery (TF-FES) as revision surgery
in patients who have previously undergone posterior lumbar surgery. There have been
several reports on the advantages of TF-FES, which include feasibility of local anesthesia,
minimal invasiveness to posterior structures, and less scar tissue with fewer adhesions.
In this study, we aim to assess the clinical outcomes of revision TF-FES and its advantages.
Methods We evaluated 48 consecutive patients with a history of posterior lumbar spine surgery
who underwent revision TF-FES (at 60 levels) under local anesthesia. Intraoperative
blood loss, operating time, and complication rate were evaluated. Postoperative outcomes
were assessed using the modified Macnab criteria and visual analog scale (VAS) scores
for leg pain, back pain, and leg numbness. We also compared the outcome of revision
FES with that of primary FES.
Results Mean operating time was 70.5 ± 14.4 (52–106) minutes. Blood loss was unmeasurable.
The clinical outcomes were rated as excellent at 16 levels (26.7%), good at 28 (46.7%),
fair at 10 (16.7%), and poor at 6 (10.0%). The mean preoperative VAS score was 6.0 ± 2.6
for back pain, 6.8 ± 2.4 for leg pain, and 6.3 ± 2.8 for leg numbness. At the final
follow-up, the mean postoperative VAS scores for leg pain, back pain, and leg numbness
were 4.3 ± 2.5, 3.8 ± 2.6, and 4.6 ± 3.2, respectively. VAS scores for all three parameters
were significantly improved (p < 0.05). There was no significant difference in operating time, intraoperative blood
loss, or the complication rate between revision FES and primary FES.
Conclusions Clinical outcomes of revision TF-FES in patients with a history of posterior lumbar
spine surgery were acceptable (excellent and good in 73.4% of cases). TF-FES can preserve
the posterior structures and avoid scar tissue and adhesions. Therefore, TF-FES could
be an effective procedure for patients who have previously undergone posterior lumbar
spine surgery.
Keywords
revision lumbar spine surgery - transforaminal full-endoscopic spine surgery - adjacent
segment disease - minimally invasive surgery - multiple operated back syndrome - complication
