Guodong YIN, Baohua HUANG, Chong WANG, Shi-qin LIU

Therapeutic effects of full endoscopic spine surgery via transforaminal approach in elderly patients with lumbar spinal stenosis: A retrospective clinical study

Objective: This study aimed to investigate the therapeutic effects of full endoscopic spine surgery on clinical and radiologicaloutcomes in elderly patients over 70 years with lumbar spinal stenosis, without any obvious segmental instability.Methods: A total of 47 patients (27 males, 20 females; the mean age=74.23±5.16) above 70 years who underwent a transforaminalpercutaneous endoscopic decompression with the diagnosis of lumbar spinal stenosis, were included in this retrospective study.The mean follow-up was 26±2.97 months. The clinical efficacy of the surgical procedure was assessed by the Oswestry disabilityindex (ODI) and the visual analog scale (VAS) of the leg and lower back at 1 week, 3 months, and 1 year postoperatively, andat the final follow-up examination. Modified MacNab criteria was also performed to assess the clinical efficiency of surgery atthe final follow-up.Results: An excellent outcome as per modified MacNab criteria was obtained in 9 patients (19.1%), a good outcome in 33patients (70.2%), a fair outcome in 3 patients (6.4%), and poor results in 2 patients (4.3%). The mean ODI score significantly improved from 71.29±5.69 preoperatively to 32.05±10.71 at postoperative 1 week, 30.27±9.89 at 3 months, 27.23±8.47 at 1 year, and23.11±9.97 at the final follow-up (p

___

1. Marawar SV, Madom IA, Palumbo M, et al. Surgeon reliability for the assessment of lumbar spinal stenosis on MRI: the impact of surgeon experience. Int J Spine Surg 2017;11: 34.

2. Choi JM, Kim SB. Perioperative results and complications after posterior lumbar interbody fusion for spinal stenosis in geriatric patients over than 70 years old. J Korean Neurosurg Soc 2017; 60: 684-90.

3. Kim JH, Kim HS, Kapoor A, et al. Feasibility of full endoscopic spine surgery in patients over the age of 70 years with degenerative lumbar spine disease. Neurospine 2018; 15: 131-7.

4. Kim HS, Paudel B, Jang JS, et al. Percutaneous full endoscopic bilateral lumbar decompression of spinal stenosis through uniportal-contralateral approach: techniques and preliminary results. World Neurosurg 2017;103: 201-9.

5. Kim HS, Ju CI, Kim SW, Kim JG. Endoscopic transforaminal suprapedicular approach in high grade inferior migrated lumbar disc herniation. J Korean Neurosurg Soc 2009; 45: 67-73.

6. Huang YH, Lien FC, Chao LY, Lin CH, Chen SH. Full endoscopic uniportal unilateral laminotomy for bilateral decompression in degenerative lumbar spinal stenosis: highlight of ligamentum flavum detachment and survey of efficacy and safety in 2 years of follow-up. World Neurosurg 2020;134: e672-e81.

7. Kapetanakis S, Gkantsinikoudis N, Thomaidis T, Charitoudis G, Theodosiadis P. The role of percutaneous transforaminal endoscopic surgery in lateral recess stenosis in elderly patients. Asian Spine J 2019; 13: 638-47.

8. Sairyo K, Chikawa T, Nagamachi A. State-of-the-art transforaminal percutaneous endoscopic lumbar surgery under local anesthesia: Discectomy, foraminoplasty, and ventral facetectomy. J Orthop Sci 2018; 23: 229-36.

9. Chen X, Qin R, Hao J. et al. Percutaneous endoscopic decompression via transforaminal approach for lumbar lateral recess stenosis in geriatric patients. Int Orthop 2019; 43: 1263-9.

10. Lin J-H, Hsieh Y-C, Chen Y-C, Wang Y, Chen C-C, Chiang Y-H. Diagnostic accuracy of standardised qualitative sensory test in the detection of lumbar lateral stenosis involving the L5 nerve root. Sci Rep 2017; 7: 10598.

11. Cassinelli EH, Eubanks J, Vogt M, Furey C, Yoo J, Bohlman HH. Risk factors for the development of perioperative complications in elderly patients undergoing lumbar decompression and arthrodesis for spinal stenosis: an analysis of 166 patients. Spine (Phila Pa 1976) 2007; 32: 230-5.

12. Choma TJ, Rechtine G, McGuire RA, Brodke DS. Treating the Aging Spine. J Am Acad Orthop Surg 2015; 23: e91-e100.

13. Allen RT, Garfin SR. The economics of minimally invasive spine surgery: the value perspective. Spine (Phila Pa 1976) 2010; 35 (26 Suppl): S375-82.

14. Ahn, Y. Current techniques of endoscopic decompression in spine surgery. Ann Transl Med 2019; 7 (Suppl 5): S169.

15. Datta S, Manchikanti L, Falco FJE, et al. Diagnostic utility of selective nerve root blocks in the diagnosis of lumbosacral radicular pain: systematic review and update of current evidence. Pain Physician 2013; 16 (2 Suppl): SE97-124.

16. Beynon R, Hawkins J, Laing R, et al. The diagnostic utility and cost-effectiveness of selective nerve root blocks in patients considered for lumbar decompression surgery: a systematic review and economic model. Health Technol Assess 2013; 17: 1-88, v-vi.