Endoscope-Assisted Revision Surgery after Lumbar Fusion with Pedicle Screw Fixation: A Case Series and Literature Review.

Abstract

Background: Lumbar internal fixation and fusion can be subject to failure requiring revision surgery. Endoscopic revision surgery with minimal invasiveness may be a helpful therapeutic intervention in the management of certain fusion-related complications. According to the author's knowledge, there are few references to this technique in English literature.

Objective: This study aimed to investigate the efficacy of endoscope-assisted revision surgery in patients with recurrent radiculopathy after lumbar fusion surgery, discuss the necessity of revision surgery, and review the relevant literature.

Material and methods: We report a case series and review relevant literature. Information was gathered from the electronic medical record in our hospital. A total of 231 patients who underwent endoscopic spine procedures from January 2021 to October 2022 were reviewed. Three patients who underwent endoscopic decompressive procedures after lumbar fusion surgeries at a correspondence segment were identified, and the clinical courses and radiological findings of these patients were retrospectively reviewed.

Results: The average interval from initial to revision surgery was 30.74 (range 10.50-48.00) months. The patients include one man and two women with an average age of 75.67 (range 68-81) years at the initial operation. Three patients developed symptoms of recurrent myelopathy after their initial surgery due to canal stenosis in the fusion segment and hyperostosis. All patients experienced symptom relief after revision surgery. At a mean follow-up time of 0.96 months, endoscopic decompression resulted in the average numerical rating scale (NRS) score for lower limb pain on the symptomatic side being reduced by 2.67. Patients rated their leg pain on average as 4.5 ± 0.5.

Conclusions: Endoscope-assisted revision surgery after lumbar fusion with pedicle screw fixation is a promising therapeutic strategy in treating recurrent radiculopathy. Spinal stenosis and hyperostosis are two of the most significant reasons for revision surgery. Resection of intraspinal lesions and endoscopic foraminal decompression appear to have promising outcomes. Certain fusion-related complications may be effectively treated with endoscope-assisted revision surgery. Further research should be conducted to investigate the clinical efficacy of revision surgery.