Asian Spine J.  2019 Aug;13(4):638-647. 10.31616/asj.2018.0179.

The Role of Percutaneous Transforaminal Endoscopic Surgery in Lateral Recess Stenosis in Elderly Patients

Affiliations
  • 1Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece. stkapetanakis@yahoo.gr

Abstract

STUDY DESIGN: Prospective clinical study. PURPOSE: To investigate the effect of percutaneous transforaminal endoscopic surgery (PTES) for lateral recess stenosis (LRS)(LRS) in elderly patients and to assess patients' health-related quality of life (HRQoL). OVERVIEW OF LITERATURE: PTES is an increasingly used surgical approach, primarily employed for lumbar disc herniation treatment. However, indications for PTES have been increasing in recent years. PTES has been recommended as a beneficial alternative to open decompression surgery in specific LRS cases; PTES is termed as percutaneous endoscopic ventral facetectomy (PEVF) in such cases.
METHODS
In total, 65 elderly patients with LRS were prospectively studied. Patients presented severe comorbidities (coronary insufficiency, heart failure, diabetes mellitus, and respiratory failure); thus, general anesthesia administration would potentially cause considerable hazards. All the patients underwent successful PEVF in 2015-2016. The patients were assessed preoperatively and at 6 weeks; 3, 6, and 12 months; and 2 years postoperatively. Patients' objective assessment was conducted according to specific clinical scales; the Visual Analog Scale (VAS) was separately used for leg and low-back pain (VAS-LP and VAS-BP, respectively), whereas the Short Form 36 Health Survey Questionnaire was used for the HRQoL evaluation.
RESULTS
All studied parameters presented maximal improvement at 6 weeks postoperatively, with less enhancement at 3 and 6 months with subsequent stabilization. Statistical significance was found in all follow-up intervals for all parameters (p<0.05). Parameters with maximal absolute amelioration were VAS-LP, bodily pain, and role limitations due to physical health problems. In contrast, VAS-BP, general health, and mental health were comparatively less enhanced.
CONCLUSIONS
PEVF was associated with remarkably enhanced HRQoL 2 years postoperatively. PEVF is thus a safe and effective alternative for LRS surgical management in elderly patients with severe comorbidities.

Keyword

Lumbar spine; Lateral recess stenosis; Percutaneous transforaminal endoscopic surgery; Percutaneous endoscopic ventral facetectomy; Quality of life

MeSH Terms

Aged*
Anesthesia, General
Clinical Study
Comorbidity
Constriction, Pathologic*
Decompression
Diabetes Mellitus
Follow-Up Studies
Health Surveys
Heart Failure
Humans
Leg
Mental Health
Prospective Studies
Quality of Life
Visual Analog Scale
Weights and Measures
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