Percutaneus endoscopic interlaminar decompression for lumbar lateral recess stenosis in elderly patients

Abstract

Objectives To assess the clinical outcomes, the technical characteristics of percutaneus endoscopic interlaminar decompression for lumbar lateral recess stenosis in elderly patients. Methods From May 2014 to June 2015, 76 elderly patients with lumber lateral recess stenosis were accepted percutaneus endoscopic interlaminar decompression, including 48 males and 28 females aged from 60-91 years old (average, 71.7±8.8 years). There were 40 patients with stenosis in L4,5, 29 patients with stenosis in L 5S1 and 7 patients with stenosis in L4,5 and L 5S1. Back and leg pain were assessed by visual analogue scale (VAS). The influence of pain was evaluated by Oswestry disability index (ODI). The change of spinal canal was assessed by lateral recess angle. The MacNab criteria was evaluated at last follow-up. Results All of the 76 operations had been completed successfully with an average operation time of 64.3±23.9 min (range, 56-98 min). An average follow-up time was 31.5 months (range, 24-36 months). There was no operative segment errors and nerve root tear during operation. Dural sac tear in 1 case, 2 cases of nerve root injury and 1 case of postoperative kakesthesia, transient seizures after anesthesia occurred in 1 case and 1 case had postoperative delirium. There were significances in lumbocrural pain scores, leg pain scores and ODI scores between preoperation and postoperative 1,3,6,12 month and last follow-up (P<0.05). In the MacNab last follow-up, the fineness rate was 92.1%, including 52 cases of excellence, 18 cases of good, and 6 cases of fair. The latera recess angle between preoperation and postoperation was significantly different. During follow-up period, there were 3 cases developed into lumbar instability. No recurrence, discitis and leakage of cerebrospinal fluid were found, delayed incision healing was found in 1 case. Conclusions Percutaneus endoscopic interlaminar decompression for lumbar lateral recess stenosis in elderly patients is a safe, effective and minimally invasive method of operation with the characteristics of precise decompression of bone stenosis, sufficient resection of ligamentum flavum to decompress soft stenosis, small effect on spinal stability and low complications. Key words: Lumbar vertebrae; Spinal stenosis; Ligamentum Flavum; Endoscopy; Aged; Treatment outcome