Percutaneous endoscopic lumbar discectomy in the elderly: An effective treatment for prolapsed disc: Consideration on 75 case

Abstract

Background: endoscopic spinal techniques are becoming widely used for lumbar disc prolapse treatment. The advantages are a milder invasivity, a shorter recovery time, lesser scar tissue formation, and the possibility to be performed under spinal or locoregional anesthesia. All of these make endoscopy suitable even in elderly patients with severe comorbidities. However, few studies have described outcomes of percutaneous endoscopic discectomy in the elderly. Here we describe and compare two prospectively collected cohorts of patients, an elderly (>75 years) and a younger one, to highlights outcomes differences between age groups. We then discuss our results with the outcomes of similar studies published in the literature. Methods: Patients older than 75 years, with a confirmed diagnosis of lumbar disc prolapse, treated by an endoscopic technique between January 2015 and June 2017, were prospectively enrolled (Group E). Clinical and demographic data were collected, as well as data on the postoperative Visual Analogue Scale and Oswestry Disability Index at 3, 6 and 18 months. We then analyze a prospectively collected cohort of younger patients (≤50 years, Group Y), to allow for comparison of postoperative results. Results: Percutaneous endoscopic lumbar discectomy was successful in 89% of elderly patients after a median follow-up of 14 months, with half of the cases discharged home after a median time of 28 h. Only two surgical complications occurred. No differences in mean postoperative leg pain was found between the two groups. A significant higher number of medical complications was found in the elderly group compared to the younger ones, and more frequently in ASA 3 or 4 patients who underwent general anesthesia. Conclusion: Our study suggests that percutaneous endoscopic lumbar discectomy is a safe and feasible procedure for disc prolapse treatment in elderly patients, especially if combined with spinal anesthesia. Keywords: Discectomy, Mini-invasive, Elderly