1	Junctional Disc Protrusions Following Spinal Fusions Treated by Minimal Invasive Spinal Surgery (MISS) John C. Chiu, M.D. Chief, Neurospine Surgery California Center for Minimally Invasive Spine Surgery Thousand Oaks, California USA
2	California Spine Institute Medical Center, Inc
3	Introduction The additional mobility and stress placed on intervertebral segments adjacent to fused cervical and lumbar spinal segments, may over time result in degeneration and protrusion of adjacent discs, i.e. JUNCTIONAL DISC SYNDROME (JDS) in POST SPINAL FUSION Its incidence is reported to be 25 to 40% of post fusion cases, within four years. At times such discs proceed up or down the spine from an original level to eventually total four or five levels, especially at the cervical spine
4	Materials and Methods A series of 60 patients; 32 males, 28 females 70% cervical, 30% lumbar post fusion recurrences Aged 37 to 76; average 44 Interval to recurrence – immediate to 11 yrs. (average 5.5 yrs.) All were treated with endoscopic microdecompressive spinal discectomy with laser thermodiskoplasty described under separate presentation
5	Materials and Methods Cervical JDS MRI showing junctional discs at C3-4 and C7-T1 following ACF C4-4 thru C6-7
6	Materials and Methods Lumbar JDS
7	Materials and Methods Intra-operative discogram L3-4 junctional disc above 2 level fusion
8	Procedure/Surgical Technique: Minimal invasive spine surgery (MISS) offers a method of treatment for these protrusions MISS does not require reopening an old wound, wide dissection of muscle, scar tissue and bone, or further bone grafting
9	Result At an average follow-up of 35.2 months (7 months to 54 months) 91.7% (55) of patients had good to excellent results 8.3% (5) patients had residual neck and leg pain There were no postoperative complications All symptoms improved
10	Discussion MISS can treat the problem of JUNCTIONAL DISC SYNDROME in POST SPINAL FUSION, as an outpatient procedure with ease It has no likelihood of a similar progression of future disc protrusions as in JUNCTIONAL DISC SYNDROME of POST SPINAL FUSION type
11	Conclusion MISS is the treatment of choice over spinal fusion and instrumentation, for all JUNCTIONAL DISC HERNIATION in POST SPINAL FUSION above or below the fusion It is an outpatient procedure performed with ease and efficacy
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