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

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.

Clinical Outcomes of TESSYS and TESSYS-ISEE Approach on Treatment of Lateral Recess Stenosis: A Comparison Study

“…Although most of our participants experienced symptom relief following procedures, however, complications (5.75%) and recurrence (1.15%) still occurred. TESSYS is emerging as an attractive minimally invasive surgical option in the treatment of LRS [12,17,18], and was routinely applied to treat LRS at our institution. TESSYS-ISEE was newly designed to treat LRS [13].…”

The role of full-endoscopic lumbar discectomy in patients with neurodegenerative disorders: Technical note and short literature review

“…[1,2,9,10] We, therefore, performed a minimally invasive TFED (e.g., preservation of dorsal musculature and spine anatomic elements, diminished traumatization, as well as minimization of intraoperative hemorrhage) under local anesthesia with mild sedation. [4][5][6][7][8] FELD has been performed in other patients with accompanying neurodegenerative disorders/Parkinson's disease (PD) [ Table 2]. [4,5] Kapetanakis et al first described performing TFED for LDH in 11 patients with PD versus ten patients with LDH and no accompanying comorbidities' comparable clinical improvement were observed in both groups.…”

“…Further, advantages include the ability to perform transforaminal full-endoscopic discectomy (TFED) or interlaminar full-endoscopic discectomy under local anesthesia and mild sedation. [4][5][6][7][8]…”

Clinical outcomes of transforaminal endoscopic lateral recess decompression by using the visualized drilled foraminoplasty and visualized reamed foraminoplasty: a comparison study

“…Although most of our participants experienced symptom relief following procedures, however, complications (5.75%) and recurrence (1.15%) still occurred. TE-LRD via VDF technique is emerging as an attractive minimally invasive surgical option in the treatment of LRS [13,18,19], and it is routinely applied to treat LRS at our institution. TE-LRD via VRF technique was newly designed to treat LRS [14].…”