• Chengyue Zhu, Yujun Zhang, Susu Sun, Rongxue Shao, Jiaming Liang, Wei Cheng, Hao Pan, and Wei Zhang.
• Department of Orthopaedics, Hangzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China.
• Medicine (Baltimore). 2023 Oct 6; 102 (40): e35466e35466.

RationaleBiportal 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 ConcernsCase 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.DiagnosesComputed 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.InterventionsUnder 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.OutcomesPostoperative parameters were improved clinically, and nerve roots were decompressed radiologically. No complications were developed.LessonsUBE revision surgery showed a favorable clinical and radiological result without complications and may be a safe and effective alternative technique for ASD.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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