Laser-assisted endoscopic lumbar foraminotomy for failed back surgery syndrome in elderly patients
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Elderly patients with failed back surgery syndrome (FBSS) or post-laminectomy foraminal stenosis have a higher risk of perioperative morbidity with extensive revision surgery. Thus, there is a need for safer and less invasive surgical options, such as laser-assisted endoscopic lumbar foraminotomy (ELF). A pin-point laser beam can allow precise tissue ablation and dissection in fibrotic adhesion tissues while preventing normal tissue injury. The present study aimed to describe the surgical technique of laser-assisted ELF and to evaluate the clinical outcomes of elderly patients with FBSS. Two-year follow-up data were collected from 26 consecutive patients aged 65 years or older who were treated with laser-assisted ELF for FBSS. Full-endoscopic foraminal decompression was performed using a side-firing laser and mechanical instruments. The average age of the patients was 70.2 years (range, 65–83 years). The mean visual analog pain score for leg pain improved from 8.58 at baseline to 3.35 at 6 weeks, 2.19 at 1 year, and 2.35 at 2 years after ELF (P < 0.001). The mean Oswestry disability index improved from 65.93 at baseline to 31.41 at 6 weeks, 21.77 at 1 year, and 20.64 at 2 years after ELF (P < 0.001). Based on the modified Macnab criteria, excellent or good results were obtained in 84.6% patients and symptomatic improvements were obtained in 92.3%. Extensive revision surgery in elderly patients might cause significant surgical morbidities. Laser-assisted ELF under local anesthesia could be a safe and effective surgical alternative for such patients at risk.
KeywordsEndoscopic Failed back surgery syndrome Foraminotomy Laser Side-firing
The authors would like to thank Jin Ah Kim, Ho Kim, Jae Min Son, and Sol Lee for their support and assistance in this study.
Y. A. conceived and designed the study, analyzed the data, and wrote the manuscript. H.J.K and S.H.S collected and analyzed the data and wrote the manuscript. J.J.C analyzed the data and edited the manuscript. All authors read and approved the manuscript.
This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health and Welfare, Republic of Korea (grant number: HI16C2319).
Compliance with ethical standards
This study was approved by the ethical committee of the study center (approval no.: WRDIRB 2016-12-012), and written informed consent was obtained from the patients.
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in the study were in accordance with the ethical standards of the Wooridul Spine Hospital and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the ethical committee of the Wooridul Spine Hospital.
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