Percutaneous endoscopic decompression via transforaminal approach for lumbar lateral recess stenosis in elderly patients

English Keywords:Lumbar lateral recess stenosis  Percutaneous endoscopic surgery  Elderly  Transforaminal approach

English Abstract:

  【Abstract】 Objectives: To investigate the surgical strategy, safety and efficacy of percutaneous endoscopic decompression via transforaminal approach for lumbar lateral recess stenosis in elderly patients. Methods: From January 2012 to June 2014, 27 elderly patients(19 males and 8 females) with lumbar recess stenosis were performed percutaneous endoscopic decompression via transforaminal approach. The age of patients ranged from 70 years to 93 years with an average of 78.9±12.2 years. Percutaneous lumbar intervertebral foramen approach for decompression of lateral recess and treatment of intervertebral foramen were used on all cases. The lumbar CT images were reexamined at 2 days after operation to evaluate the foraminoplasty and decompression of the lateral recess. The leg pain VAS scores and Oswestry Disability Index(ODI) scores were recorded preoperatively and at 1 month, 3 months, 6 months and 12 months after operation, statistical analysis was performed. The MacNab scores were evaluated at 12 months after operation. Results: The operation was successfully completed on 25 patients, 1 case could not tolerate pain changed to open surgery, 1 case had myocardial ischemia and gave up surgery. The average operation time was 75±28 minutes(range, 50-110 minutes). The lumbar CT images at 2 days after operation demonstrated the distinct enlargement of the foramen and the satisfactory decompression of lateral recess. 24 patients were followed up for a mean duration of 29±14 months(range, 12-44 months). The leg pain VAS score decreased from 8.52±1.11 preoperatively to 1.80±0.63, 1.33±0.89, 1.05±0.69 and 0.71±0.50 at 1, 3, 6, 12 months after operation respectively. The ODI score also decreased from 59.43±10.04 preoperatively to 29.42±10.33, 20.13±8.18, 13.98±6.16 and 9.86±5.03 at 1, 3, 6, 12 months after operation respectively. Statistically significant differences existed in both VAS score(F=8.33, P<0.01) and ODI score(F=24.09, P<0.01) at each postoperative follow-up time point when compared with the preoperative scores. There were 18 excellent cases, 3 good cases and 3 fair cases according to the modified MacNab criteria, and the excellent and good rate was 87.5% at 12 months after operation. There was no aggravation of the coexisting medical conditions after operation in this group. Only 1 case was found complicated with low extremity numbness, which recovered by conservative treatment for two weeks. No persistent neurological deficit and infect were founded in all patients. Conclusions: Percutaneous endoscopic decompression via transforaminal approach provides a safe, effective and less invasive alternative for treating lumbar lateral recess stenosis in elderly patients. This technique can be performed under simple local anesthesia and has less impact on the general condition of patients.