Advances in Endoscopic Spine Surgery for the Elderly

Introduction: As the global population ages, degenerative lumbar spine conditions become increasingly prevalent among the elderly. Traditional open spine surgery carries higher risks and longer recovery times in this group. Endoscopic spine surgery offers a minimally invasive alternative with potential for reduced complications and better outcomes, yet its adoption remains limited. This systematic review evaluates current evidence on endoscopic techniques for treating lumbar spinal pathology in elderly patients.

Methods: We systematically searched Embase, PubMed, and Cochrane Library databases up to October 2023 with the help of a medical librarian, using terms related to "endoscopic spine surgery" and "elderly." After removing duplicates, 5,811 articles were identified. Inclusion criteria were peer-reviewed studies on endoscopic lumbar spine surgery in elderly patients reporting clinical outcomes and complications. Exclusion criteria included non-peer-reviewed articles, irrelevant studies, and non-English publications without translation. Five reviewers independently screened articles, resulting in 134 studies included in the review.

Results: The 134 studies encompassed over 10,000 elderly patients with mean ages ranging from 65 to 90 years. Endoscopic procedures demonstrated significant improvements in pain and function, with mean Visual Analog Scale (VAS) score reductions of 4.5 points and Oswestry Disability Index (ODI) reductions of 20%. Complication rates were low: dural tears occurred in 2%, infections in 1%, and reoperation rates were less than 5%. Compared to open surgery, endoscopic techniques had shorter operative times, less blood loss, and reduced hospital stays.

Conclusion : Endoscopic spine surgery is a safe and effective alternative to open surgery for lumbar spinal pathology in the elderly, offering reduced complications and improved recovery. surgery. The minimally invasive nature reduces perioperative risks and accelerates recovery, benefiting elderly patients with comorbidities. Challenges include a steep learning curve for surgeons and the need for specialized equipment, which may limit widespread adoption.