Clinical Study On The Treatment Of Geriatric Lumbar Degenerative Diseases With Percutaneous Endoscopic Lumbar Decompression

Part1 Comparison of Effects of PELD and Fenestration in the Treatment of Geriatric Lumbar Lateral Recess StenosisPurpose: Although degenerative lumbar spinal stenosis(LSS)is increasingly being diagnosed in older people,there is much uncertainty about the appropriate operative treatment options.The objective of this study is to compare the outcome of percutaneous endoscopic lumbar decompression(PELD)versus fenestration for lumbar lateral recess stenosis(LRS)in geriatric patients over 75 years old.Materials and methods: This prospective controlled study was performed for 46 consecutive over aged patients with lateral recess stenosis who underwent either PELD or fenestration.Clinical data was recorded before,1 week,3 months and 1.5 years after surgery using Visual analogue scale(VAS),Japanese Orthopaedic Association Score(JOA),The ShortForm-36(SF-36)and the modified Macnab evaluation criteria.Results: The patients’ mean age was 82.7 years(aged 75–93 years)in PELD group and 79.1 years(aged 75-88 years)in fenestration group.No statistical difference was found between PELD group and fenestration group with regards to VAS-back pain,VAS-leg pain,JOA and at 3 months and 1.5-year follow-up.However,the PELD group had a lower mean VAS for back pain at 1 week postoperatively(P<0.05).The quality of life in PELD group achieve the same remarkable improvement as fenestration group(P>0.05).Operative time(min)was similar between two groups(p>0.05),while the PELD techniques brought advantages in blood loss(ml)(48.3 vs 128.2,p<0.05),early ambulation(h)(5.5 vs 25.2,p<0.05)and anesthesiarelated complications.Conclusions: Both PELD and fenestration showed favorable clinical outcomes for the treatment of lumbar lateral recess stenosis.In addition,PELD had advantages in reduced traumatization and less anesthesia-related complications.In terms of quality of life and complications after operation,PELD under local anesthesia could be an efficient supplement to conventional decompression surgery in geriatric patients with lumbar lateral recess stenosis.Part2 Endoscopic Ventral Decompression for Spinal Stenosis with Degenerative Spondylolisthesis by Partially Removing Posterosuperior Margin Underneath the Slipping Vertebral Body: Technical Note and Outcome EvaluationPurpose: Decompression alone is a treatment option in patients with lumbar spinal stenosis(LSS)and degenerative lumbar spondylolisthesis(DLS).This study aims to describe the procedure of percutaneous transforaminal endoscopic ventral decompression technique and to demonstrate the clinical outcomes.Methods: Two years of retrospective data were collected from 26 patients with predominant unilateral leg pain caused by LSS and low-grade DLS(Meyerding grades I and Ⅱ).All patients underwent endoscopic ventral decompression by removing the posterosuperior margin underneath the slipping vertebral body,combined with dorsal decompression without excessive resection of facet joints.The surgical outcomes were assessed using the visual analog scale(VAS),Oswestry Disability Index(ODI),modified Mac Nab criteria,and walking distance improvement evaluation.Results: The mean age of the 18 women and 8 men was 69.2 years.The mean preoperative ODI and VAS of the leg and the back scores were 64.7±8.1,7.0±1.4,and 3.0±1.2,respectively.All mean scores improved postoperatively to 31.4±5.6,2.4±1.1,and 1.7±1.1 at the final follow-up.In 88.5% of cases,patients’ estimated walking distance improved.The outcomes of the modified Mac Nab criteria showed that 81.3% of patients obtained good-to-excellent rate.There were no statistically significant differences between the percent slip of spondylolisthesis before surgery and at the end of follow-up.Conclusions: Based on the initial short-term follow-up results,transforaminal endoscopic ventral decompression by partially removing the posterosuperior margin underneath the slipping vertebral body,combined with dorsal decompression,might be an efficient alternative treatment for leg dominant symptoms in patients with LSS and low-grade DLS.Part3 Comparison between percutaneous transforaminal endoscopic discectomy and interlaminar fenestration on perioperative anxiety in patients with lumbar disc herniationPurpose: Percutaneous transforaminal endoscopic discectomy(PTED)has been widely applied and popularized in recent years.To date,however,few study has explored the surgical effect of this technique on perioperative anxiety in patients with lumbar disc herniation(LDH).To compare the effects of PTED and fenestration on perioperative anxiety in patients with LDH.Methods: From October 2018 to January 2019,31 patients with LDH who underwent PTED and 33 patients with LDH who underwent fenestration at our hospital were enrolled in this study.Anxiety was evaluated by STAI(State-Trait Anxiety Inventory)at admission time,at 1 hour before surgery,at 1 day after surgery and at discharge time.Visual Analog Scale(VAS)and Oswestry Disability Index(ODI)was used to assess the surgical outcomes of patients on admission and discharged from hospital.Results: Both PTED and fenestration groups showed improvements in VAS and ODI scores;There were no significant difference in STAl scores,VAS for back pain,VAS for leg pain and ODI scores at admission and discharge time point.However,Patients in PTED group recorded a lower STAl scores at 1 hour before surgery and at 1 day after surgery(P<0.05)and lower VAS for back pain in first day after surgery than that in fenestration group(P<0.05).Conclusions: For patients with LDH,PTED is no less effective than that of traditional open surgery,and it can reduce the anxiety state of patients during perioperative period.