Abstract

Clinical outcome of Percutaneous Transforaminal Endoscopic Lumbar Surgery (PTELS) in patient above 60 years of age with lowback pain

Author(s): Singh Ratish, Hirachan Mangal P, Gao Zeng Xin* & Lin Yu Cheng

Background: Percutaneous Transforaminal Endoscopic Lumbar Surgery (PTELS) is the latest advance minimal invasive surgical technique in treatment of low back pain. Objective: To evaluate the outcome of Percutaneous Transforaminal Endoscopic Lumbar Surgeries in patient above 60 years of age and to appraise the efficacy of this technique in treatment of lumbar disc herniation and lumbar spine stenosis in these age group patients. Materials and Methods: Total 77 patients with age more than 60 years were retrospectively studied, among which 45 patients presented with Lumbar Disc Herniation (LDH) and 22 patients with Lumbar Spinal Stenosis (LSS) who had undergone Percutaneous Transforaminal Endoscopic Lumbar surgery (PTELS) in Zhongda Hospital Affiliated Southeast University from June 2013 to June 2016 A.D. The calculated mean follow up was 20.87 months. Results: Mean age of operated patient was 68.33 years. Average time of surgery was 87.31+24.746 minutes. And average hospital stay after surgery was 4.79+2.711 days. The preoperative and postoperative Oswestry Disability Index (ODI) was (52.8022+11.98299, 16.3513+12.97398, p=0.000) indicating statistical significance. The Visual Analog Scale (VAS) of leg and back was (6.27+1.213, 4.79+1.162) and (1.40+1.688, 1.30+1.436) p=0.00, p=0.00 respectively with significant difference before and after surgery. On the basis of MacNab criteria 76.1% of patients showed excellent or good, 10% showed fair and 6% with poor outcome. Overall complication was 10.5% out of which 3% (2 cases) were of incomplete removal of content and 7.5% (5 cases) were of reherniation. In Lumbar Disc Herniation (LDH) there were total 45 patients, of which 26 males and 19 females. In Lumbar Spinal Stenosis (LSS) there were total 22 patients, of which 8 males and 14 females. Time of operation in two group were 87.67+25.486 and 86.59+23.724 minute respectively with p=0.537 which showed no significance difference between two groups. Hospital stay after surgery was 5.09+3.088 and 4.18+1.593 days respectively with p=0.484. There was no statistically clinical significance difference found between LDH and LSS on the basis of Oswestry Disability Index (ODI) p=0.863, 9 Visual Analog Scale (VAS) leg and back p=0.193, p=0.897, MacNab criteria p= 0.090. Conclusion: Percutaneous Transforaminal Endoscopic Lumbar Surgery can be a good alternative technique in spine surgery to relieve symptoms for low back pain with satisfactory outcome, short hospital stay and advantage regarding no need of general anesthesia for elder patient. There is no significant difference between the clinical outcome of Percutaneous Transforaminal Endoscopic Lumbar Surgery (PTES) between lumber disc herniation and lumber spine stenosis of patient above 60 years of age.