Clinical Efficacy Evaluation of Percutaneous Endoscopic Interlaminar Decompression Under Local Anesthesia for the Treatment of Degenerative Lumbar Spinal Stenosis in Elderly Patients with Medical Comorbidities: A Multicenter Retrospective Study.

OBJECTIVE

Percutaneous endoscopic interlaminar discectomy (PEID) is recognized as a safe and effective minimally invasive treatment for lumbar spinal stenosis (LSS). This study introduces a novel awake PEID strategy that involves the use of conscious sedation with stepwise local anesthesia (LA) as an alternative to general anesthesia (GA). The objective of this study was to evaluate the feasibility of awake PEID in elderly patients with degenerative lumbar spinal stenosis (DLSS) and multiple comorbidities.

METHODS

This retrospective analysis included 123 consecutive patients older than 70 years with comorbidities who underwent awake PEID for DLSS at 4 hospitals between January 2022 and January 2024. The operation time, blood loss, and hospital stay were recorded. Clinical outcomes were evaluated with the visual analog scale (VAS) for leg and back pain, the Oswestry Disability Index, and the Japanese Orthopaedic Association score at baseline and at 3 days, 3 months, 6 months, and 12 months postoperatively. Surgical efficacy was assessed at the final follow-up using the modified Macnab criteria. Complications and adverse events were documented. Intraoperative anesthesia effectiveness and patient experience were measured with the intraoperative VAS score and a satisfaction scale. Descriptive statistics and multiple comparison tests were applied to compare surgical indicators, and longitudinal data were analyzed with generalized linear mixed models.

RESULTS

All patients successfully completed PEID under local anesthesia with conscious sedation. Overall, 100 patients (81%) rated their intraoperative experience as excellent or good, and 23 patients (19%) rated it as fair. The mean intraoperative VAS score was 3.4 ± 1.1. Compared with baseline, leg and back pain VAS scores and Oswestry Disability Index scores improved significantly at all follow-up intervals (P < 0.01). At the final follow-up, 116 patients (94%) achieved excellent or good outcomes according to the modified Macnab criteria, whereas 7 patients (6%) achieved fair results. No patient discontinued surgery because of intolerable pain.

CONCLUSIONS

PEID under local anesthesia is feasible for elderly patients with LSS and severe comorbidities. The anesthesia strategy described in this study was safe, simple to implement, and associated with fewer anesthesia-related adverse effects. Thus, in selected patients, particularly elderly patients with multiple comorbidities, this approach may serve as a promising alternative to general anesthesia.