Efficacy Comparison of Arthroscopic-assisted Uniportal Spinal Surgery and Percutaneous Endoscopic Discectomy for Adjacent Segment Lumbar Disc Herniation After Fusion Surgery

Background Adjacent segment lumbar disc herniation (ASLDH), a recognized complication following lumbar fusion (LF) surgeries, can be managed with various techniques; however, evidence supporting the arthroscopic-assisted uniportal spinal surgery (AUSS) technique for adjacent segment LDH is currently lacking. Objective To explore the application and validate the safety and efficacy of Arthroscopic-assisted Uniportal Spinal Surgery (AUSS) in the treatment of adjacent segment LDH. Methods One hundred and twelve patients diagnosed with ASLDH were enrolled from 2018 to 2024. Fifty-five patients underwent the AUSS technique, comprising the AUSS group, and fifty-seven patients received percutaneous endoscopic lumbar discectomy (PELD), comprising the PELD group. Perioperative indicators, including 6-month postoperative efficacy rate, postoperative complications, Visual Analogue Scale (VAS), Japanese Orthopaedic Association (JOA) scores, Oswestry Disability Index (ODI), and Short Form-36 Survey Scale (SF-36), were recorded and compared between the two groups at each follow-up time point. Results Compared with PELD, AUSS demonstrated a shorter operation time and hospital stay, as well as less blood loss (P < 0.001). The overall efficacy rate in the AUSS group (98.2%) was higher than that in the PELD group (86.0%, P < 0.05) at 6 months postoperatively, and the total incidence of postoperative complications in the AUSS group (3.6%) was lower than that in the PELD group (28.1%, P < 0.001). At each follow-up time point, indicators of serum pain mediators, VAS-Back Pain (VAS-BP), VAS-Leg Pain (VAS-LP), JOA and ODI scores, and each dimension of SF-36 in the AUSS group were superior to those in the PELD group (P < 0.001). Conclusion Both the AUSS technique and PELD represent viable surgical options for ASLDH following LF. However, AUSS demonstrates significantly superior functional recovery rates and a lower incidence of procedure-related complications, supporting its broader clinical application.