Clinical Efficacy Evaluation of Percutaneous Endoscopic Interlaminar Decompression under Local Anaesthesia for the Treatment of Degenerative Lumbar Spinal Stenosis in Elderly Patients with Medical Comorbidities:A multicenter retrospective study.

Abstract

Percutaneous endoscopic interlaminar discectomy (PEID) is recognized as a safe and effective minimally invasive treatment for lumbar spinal stenosis (LSS). This study introduces a novel awake PEID strategy that involves the use of conscious sedation with stepwise local anaesthesia (LA) as an alternative to general anaesthesia (GA). The objective of this study was to evaluate the feasibility of awake PEID in elderly patients with degenerative lumbar spinal stenosis (DLSS) and multiple comorbidities. This retrospective analysis included 123 consecutive patients older than 70 years with comorbidities who underwent awake PEID for DLSS at four hospitals between January 2022 and January 2024. The operation time, blood loss, and hospital stay were recorded. Clinical outcomes were evaluated with the visual analogue scale (VAS) for leg and back pain, the Oswestry Disability Index (ODI), and the Japanese Orthopaedic Association (JOA) score at baseline and at 3 days, 3 months, 6 months, and 12 months post-operatively. Surgical efficacy was assessed at the final follow-up using the modified Macnab criteria. Complications and adverse events were documented. Intraoperative anaesthesia effectiveness and patient experience were measured with the intraoperative VAS score and a satisfaction scale. Descriptive statistics and multiple comparison tests were applied to compare surgical indicators, and longitudinal data were analysed with generalized linear mixed models. All patients successfully completed PEID under local anaesthesia with conscious sedation. Overall, 100 patients (81%) rated their intraoperative experience as excellent or good, and 23 patients (19%) rated it as fair. The mean intraoperative VAS score was 3.4±1.1. Compared with baseline, leg and back pain VAS scores and ODI scores improved significantly at all follow-up intervals (p < 0.01). At the final follow-up, 116 patients (94%) achieved excellent or good outcomes according to the modified Macnab criteria, whereas 7 patients (6%) achieved fair results. No patient discontinued surgery because of intolerable pain. PEID under local anaesthesia is feasible for elderly patients with LSS and severe comorbidities. The anaesthesia strategy described in this study was safe, simple to implement, and associated with fewer anaesthesia-related adverse effects. Thus, in selected patients, particularly elderly patients with multiple comorbidities, this approach may serve as a promising alternative to general anaesthesia.