1	"John C." John C. Chiu, D.Sc., M.D., FRCS Chief Neurospine Surgery California Spine Institute Thousand Oaks, California, USA
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3	The Goal of Endoscopic Minimally Invasive Spinal Surgery (MISS) This presentation is to demonstrate the MISS surgical treatment for post spinal fusion - junctional disc herniation syndrome (JDHS) with segmental motion preservation
4	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. Post Spinal Fusion - Junctional Disc Herniation Syndrome (JDHS) 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
5	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
6	Indications: Post ACF fusion C4 – C6 JDHS MRI showing junctional discs at C3-4 and C7-T1 Anterior endoscopic cervical microdiscectomy (AECD) provides relief
7	Materials and Methods: Lumbar JDHS
8	Procedure/Surgical Technique: Minimal invasive spine surgery (MISS) offers a method of treatment for these protruded discs 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 Post Spinal Fusion - Junctional Disc Herniation Syndrome (JDHS), as an outpatient procedure with ease No likelihood of a similar progression of future disc protrusions as in Post Spinal Fusion - Junctional Disc Herniation Syndrome (JDHS) type
11	Conclusion: MISS is the treatment of choice over spinal fusion and instrumentation, for all Post Spinal Fusion - Junctional Disc Herniation Syndrome (JDHS) above or below the fusion It is an outpatient procedure performed with ease and efficacy
12	Hope you enjoyed this presentation!