An analysis of clinical outcomes of percutaneous endoscopic transforaminal discectomy for lumbar disc herniation in the elderly

Abstract

Objective To investigate the surgical techniques and clinical effects of percutaneous endoscopic transforaminal discectomy in the treatment of lumbar disc herniation in elderly patients. Methods A total of 67 patients with lumbar disc herniation in the elderly were treated by percutaneous endoscopic transforaminal discectomy from January 2016 to June 2018. There were 24 males and 43 females, whose average age was 68±7 years (range, 60-87 years). All cases had responsible single-level lumbar disc herniation, L3-4 in 11 cases, L4-5 in 42, L5-S1 in 14. The Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and modified MacNab criteria were used for the evaluation of clinical effects. Results The operation was completed successfully in all cases, The mean operation time was 105±18 min (range: 60-150 min). The 67 patients were followed up for 6-12 months (average 7.5±1.6 months), low back and leg pain, sensory disturbance and muscle weakness were alleviated in different degrees after the operation except for 1 patient. The VAS scores of low back pain and leg pain were (3.5±1.2) and (8.0±1.1) point preoperatively, (1.7±0.9) and (1.0±1.6) point at 6-12 months after the operation. The ODI scores were (70±18) preoperatively and (17±10) at 6-12 months after the operation. Statistically significant differences existed in the VAS scores of low back and leg pain and ODI scores preoperatively and at 6-12 months after the operation (t=13.718, t=30.973, t=23.059, P=0.000). The excellent and good rate was 89.55% in the latest follow up according to the modified MacNab criteria. There were no dural tears, nerve injuries and infections. 3 patient experienced neck pain during operation. The postoperative complications included transient lower limb numbness and pain in 5 cases, persistent leg pain caused by incomplete endoscopic discectomy in 2 cases, opposite leg pain occurring in 1 case, more severe low back pain in 2 cases, reoccurrence in 1 case. Conclusions Percutaneous endoscopic transforaminal discectomy for responsible single-level lumbar disc herniation in the elderly presents satisfactory short-term clinical outcomes due to reliable surgical technique and appropriate patients. Key words: Aged; Lumbar vertebrae; Discectomy; Endoscopy; Transforaminal approach