Managing lumbar adjacent segment disease: A description of minimally invasive techniques and algorithm.

Purpose: To manage symptomatic lumbar adjacent segment disease effectively using minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) techniques. Methods: This study presents a tailored, step-by-step guide for managing lumbar adjacent segment disease (ASD) using MIS-TLIF techniques in patients with prior spinal fusion surgeries, whether open or minimally invasive. Four distinct surgical approaches are outlined, each selected based on the time elapsed since the primary surgery, the level of ASD involvement, and the fusion status of the previously operated segment. The study includes patients who underwent surgical treatment for lumbar ASD between January 2008 and December 2023. Results: A total of 23 cases were surgically treated using four different techniques. The study age group was from 40 to 80 years (Mean age: 68.5 years). None of them had to be converted to open surgery. Patients operated using the described techniques reported significant clinical improvements, with the mean Oswestry Disability Index decreasing from 58.47 ± 6.07 to 22.58 ± 3.299 and the Visual Analog Scale scores improving from 7.076 ± 1.04 to 1.9 ± 0.77 of the preoperative symptoms. Conclusion: Drawing on their extensive clinical experience, the authors provide valuable insights into the management of lumbar ASD using an algorithmic approach based entirely on posterior minimally invasive surgical techniques.