Awake, Transforaminal Endoscopic Lumbar Spine Surgery in Octogenarians: Case Series.

Background: Optimal approaches for treating surgical spine pathology in very geriatric patients, such as those over the age of 80, remain unclear.

Objective: To describe outcomes of awake, transforaminal endoscopic surgical treatment for patients 80 years old and older presenting with lumbar radiculopathy.

Study Design: Retrospective case review.

Methods: The records of 52 consecutive patients who underwent awake transforaminal lumbar endoscopic decompression surgery performed by a single surgeon at a single institution between 2014 and 2019 were retrospectively reviewed. All included patients were followed for at least one year after surgery.

Results: Transforaminal surgeries performed were discectomies (21), foraminotomies (7), redo foraminotomies post-laminectomy (5), fusion explorations (13), facet cyst resections (3), spondylolisthesis decompressions (2), and a decompression for metastatic disease (1). Seven patients (13.5%) required repeat surgery at the treated level during the one-year follow-up. For the remaining 45 patients, at one-year follow-up, preoperative visual analog scale (VAS) for leg pain and Oswestry disability index (ODI) improved from 6.9 (± 1.4) and 40.5% (± 11.5) to 1.8 (± 1.4) and 12.0% (± 10.8), respectively. The only complication of the procedure was a single durotomy (2%).

Limitations: Single-center, retrospective case review with a relatively small number of cases with diverse clinical pathology. A multi-center case study with a larger number of patients with a more homogeneous case pathology would be more revealing.

Conclusions: Endoscopic spine surgery offers octogenarians a safe and effective option for the treatment of lumbar degenerative spine disease and may represent a valuable treatment strategy in a growing patient population.