Unilateral Biportal Endoscopic Decompression for Degenerative Lumbar Spinal Stenosis Under Local Anesthesia in Elderly Patients with Medical Comorbidities.

Abstract

Objective: Conventional Unilateral Biportal Endoscopic (UBE) surgery usually requires general anesthesia (GA), which introduces additional risks to patients with significant medical comorbidities. This article explores the use of UBE decompression under local anesthesia (LA) in elderly patients with severe medical comorbidities treated at our institution, providing valuable clinical insights for the application of this technique.

Methods: A retrospective analysis was conducted on patients clinically diagnosed with lumbar spinal stenosis (LSS) at our center between November 2021 and March 2024, who underwent UBE decompression surgery under local LA. The data collected included demographics, visual analog scale (VAS) scores for leg pain, oswestry disability index (ODI), and modified Macnab grades. The UBE decompression procedure was divided into seven key steps, and intraoperative pain and the effectiveness of LA were assessed using patient self-reported VAS scores at each step. Data comparisons between the preoperative, postoperative, and follow-up time points were conducted using paired sample t-tests.

Results: Eighteen patients (5 males and 13 females) with an average age of 77.1 ± 5.0 years were included in the study, with 83.3% (15 patients) having medical comorbidities. The average follow-up period was 14.8 ± 7.9 months. At 3 months postoperative and final follow-up, both VAS scores for leg pain (p < 0.001) and ODI scores (p < 0.001) showed significant improvement. According to the modified Macnab criteria, outcomes were rated as excellent in 13 patients (72.2%), good in one (5.6%), fair in two (11.1%), and poor in one (5.6%), yielding an excellent-good rate of 77.8%. None of the patients voluntarily requested surgery termination because of unbearable intraoperative pain.

Conclusions: For elderly patients with medical comorbidities, UBE decompression under LA is a viable and effective treatment option, yielding favorable clinical outcomes.