Feasibility of Full Endoscopic Spine Surgery in Patients Over the Age of 70 Years With Degenerative Lumbar Spine Disease

Abstract

Background/AimsDegenerative spine disease, encompassing disc prolapse and stenosis, is a common ailment in old age. This prospective study was undertaken to evaluate the role of endoscopic spine surgery in elderly patients (above 70 years of age) with clinical and radiological follow-up. MethodsIn this study, a retrospective analysis was conducted of 53 patients with lumbar disc prolapse or spinal stenosis who were treated with percutaneous endoscopic discectomy or decompression from November 2015 to June 2017. Clinical follow-up was done at 1 week, 3 months, and 1 year, and at yearly intervals thereafter. The outcomes were assessed using the modified Macnab criteria, a visual analogue scale, and the Oswestry Disability Index. ResultsOf the 53 patients, 21 were men and 32 were women. Their mean age was 76±4 years. The mean follow-up period was 17 months. Percutaneous endoscopic discectomy was performed in 24 patients and endoscopic decompression in 24 patients, while 5 patients underwent combined surgery. An excellent outcome in terms of the MacNab criteria was observed in 9 patients (16.98%), a good outcome in 38 patients (71.7%), and a poor outcome in 6 patients (11.3%). Of the 6 patients with a poor outcome, 5 (9.4%, 5 of 53) developed recurrent disc prolapse, and 1 developed hematoma with motor weakness. All 6 of these cases required revision surgery. ConclusionManaging degenerative spine disease in elderly patients with multiple comorbidities is a challenging task. Percutaneous endoscopic spine surgery is pivotal for addressing this concern. The authors have shown that optimal results can be achieved with various types of disc prolapse and stenosis with favorable long-term outcomes.

Lumbar Endoscopic Unilateral Laminotomy for Bilateral Decompression Outside-In Approach: A Proctorship Guideline With 12 Steps of Effectiveness and Safety

“…Overall revision rate is 1.9%, incidental durotomy rate around 0%-8.6%, transient paresthesia around 2.6%, epidural hematoma and headache each around 1.9%. 3,7,12,[22][23][24][25][26] These complications are comparable in some and favorable in other studies as compared to open and minimally invasive spinal decompression. [27][28][29][30][31] Infection rate is extremely low in minimally invasive surgery.…”

“…22 Despite significant steep learning curve, clinical results had been favorable. 3,7,12,[22][23][24] Complications rate ranges from 8.3%-16%. Most of the complications are temporary.…”

Development of Endoscopic Spine Surgery for Healthy Life: To Provide Spine Care for Better, for Worse, for Richer, for Poorer, in Sickness and in Health

“…However, these complications can be potentially avoided with various endoscopic spinal procedures that can be done under local anaesthesia and epidural anaesthesia, which allow for early postoperative recovery and mobility without a significant effect on the central nervous system. [32][33][34][35][36]…”

Radiographic outcomes of endoscopic decompression for lumbar spinal stenosis

“…Endoscopic laminectomy has been shown to have equal long-term outcomes when compared with open surgery with the potential for decreased postoperative pain, complications, and hospital length of stay. 10,12,13 Second, the study lacks a comparison group that underwent lumbar laminectomy via open or tubular means. However, the objective of this study was not to demonstrate the superiority of endoscopy over open or tubu-lar approaches, or vice versa.…”