Comparison of Effects of PELD and Fenestration in the Treatment of Geriatric Lumbar Lateral Recess Stenosis

Abstract

Purpose: 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 was 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 on 46 consecutive over aged patients with lateral recess stenosis who underwent either PELD or fenestration. Clinical data were recorded before, 1 week, 3 months and 1.5 years after surgery using visual analog scale (VAS), Japanese Orthopaedic Association Score (JOA), The Short-Form-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 achieved 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 anesthesia-related complications.

Conclusion: Both PELD and fenestration showed favorable clinical outcomes for the treatment of lumbar lateral recess stenosis. In addition, PELD had advantages such as 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.

Keywords: PELD; geriatric patients; lumbar lateral recess stenosis; minimally invasive; percutaneous endoscopic lumbar decompression.

Figure 1

Clinical outcomes before and after endoscopic decompression at different follow-up time points in PELD group and fenestration group. (A) Visual analog scale (VAS) scores for back pain. (B) VAS scores for leg pain. (C) Japanese Orthopaedic Association Score (JOA) scores.

Figure 2

Outcomes of 36-Item Short-Form Health Survey (SF-36) before and at the final follow-up. Abbreviations: PF, physical functioning; RP, role-physical; BP, bodily pain; GH, general health; VT, vitality; SF, social functioning; RE, role emotional; MH, mental health; HT, health transitions.

Figure 3

Satisfaction rates according to the modified Macnab criteria in PELD group (A) and fenestration group (B) at the final review (18 months) post-surgery.

Figure 4

An 81-year-old female patient with lumbar lateral recess stenosis (LRS) who received PELD. (A) Preoperative magnetic resonance images (MRI) showing severe lateral recess stenosis with LRS at the left L4-5 level (yellow arrowhead). (B) Postoperative MRI showing a thorough nerve decompression (yellow arrowhead).

Figure 5

A 76-year-old male patient with lumbar lateral recess stenosis (LRS) who received fenestration. (A) Preoperative computed tomography (CT) images showing severe lateral recess stenosis with LRS at the left L4-5 level (yellow arrowhead). (B) Postoperative CT images showing a thorough nerve decompression (yellow arrowhead).