Full Endoscopic Transforaminal Decompression Surgery for Symptomatic Lumbar Spinal Stenosis in Geriatric Patients.

Abstract

Recently, full endoscopic transforaminal decompression surgery (FETDS) under local anesthesia has been used to treat symptomatic lumbar spinal stenosis (SLSS) in selective patients. Considering the minimal injury associated with this technique, it has a potential advantage for geriatric patients. In addition, combining thorough preoperative assessments and preparations with this technique to achieve a safer and more effective outcome for geriatric patients with SLSS is necessary. Between June 2015 and September 2016, after thorough preoperative assessments and preparations, 56 geriatric patients who underwent FETDS with a median 18 months follow-up were enrolled in this study. Clinical results were assessed using the Oswestry Disability Index, visual analog scale (VAS), and the modified Macnab criteria. The median duration of surgery was 75 minutes. The mean VAS score for preoperative leg pain was 6.54 ± 0.66, which improved to 1.79 ± 0.80, 1.50 ± 0.79, 1.43 ± 0.85, and 1.39 ± 0.97 after surgery, at 3 months, at 6 months, and at the last follow-up, respectively. The mean VAS score for preoperative low back pain was 2.00 ± 1.01, which changed to 2.09 ± 0.79, 2.07 ± 0.83, 2.09 ± 0.92, and 2.23 ± 0.76 at the same evaluation times, respectively. The mean preoperative Oswestry Disability Index was 69.30 ± 6.07, which improved to 22.36 ± 8.35, 22.32 ± 8.47, 22.21 ± 6.61, and 24.57 ± 8.23, respectively. The modified Macnab criteria were consistent with excellent or good outcomes in 91.1% of patients. Three patients (5.4%) developed complications. FETDS was effective and safe in the treatment of SLSS in geriatric patients, with minimal physiologic impact, taking advantage of the current protocol of thorough assessments and appropriate preoperative preparation.