Abstract
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.
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North RB, Campbell JN, James CS, Conover-Walker MK, Wang H, Piantadosi S, Rybock JD, Long DM (1991) Failed back surgery syndrome: 5-year follow-up in 102 patients undergoing repeated operation. Neurosurgery 28:685–690
Chan CW, Peng P (2011) Failed back surgery syndrome. Pain Med 12:577–606
Baber Z, Erdek MA (2016) Failed back surgery syndrome: current perspectives. J Pain Res 9:979–987
Sebaaly A, Lahoud MJ, Rizkallah M, Kreichati G, Kharrat K (2018) Etiology, evaluation, and treatment of failed back surgery syndrome. Asian Spine J 12:574–585
Yeung A, Gore S (2014) Endoscopic foraminal decompression for failed back surgery syndrome under local anesthesia. Int J Spine Surg 8. https://doi.org/10.14444/1022 eCollection
Knight MT, Jago I, Norris C, Midwinter L, Boynes C (2014) Transforaminal endoscopic lumbar decompression & foraminoplasty: a 10 year prospective survivability outcome study of the treatment of foraminal stenosis and failed back surgery. Int J Spine Surg 8. https://doi.org/10.14444/1021 eCollection
Eichholz KM, Ryken TC (2003) Complications of revision spinal surgery. Neurosurg Focus 15:E1
Gu G, Wang C, Gu X, Zhang H, Zhao Y, He S (2018) Percutaneous transforaminal endoscopic discectomy for adjacent segment disease after lumbar fusion in elderly patients over 65 years old. World Neurosurg 112:e830–e836
Jones AA, Stambough JL, Balderston RA, Rothman RH, Booth RE Jr (1989) Long-term results of lumbar spine surgery complicated by unintended incidental durotomy. Spine (Phila Pa 1976) 14:443–446
Brotchi J, Pirotte B, De Witte O, Levivier M (1999) Prevention of epidural fibrosis in a prospective series of 100 primary lumbo-sacral discectomy patients: follow-up and assessment at re-operation. Neurol Res 21:S47–S50
Wang JC, Bohlman HH, Riew KD (1998) Dural tears secondary to operations on the lumbar spine. Management and results after a two-year-minimum follow-up of eighty-eight patients. J Bone Joint Surg Am 80:1728–1732
Morgan-Hough CV, Jones PW, Eisenstein SM (2003) Primary and revision lumbar discectomy. A 16-year review from one centre. J Bone Joint Surg (Br) 85:871–874
Patel MS, Braybrooke J, Newey M, Sell P (2013) A comparative study of the outcomes of primary and revision lumbar discectomy surgery. Bone Joint J 95-B:90–94
Blecher R, Anekstein Y, Mirovsky Y (2014) Incidental dural tears during lumbar spine surgery: a retrospective case study of 84 degenerative lumbar spine patients. Asian Spine J 8:639–645
Cammisa FP Jr, Girardi FP, Sangani PK, Parvataneni HK, Cadag S, Sandhu HS (2000) Incidental durotomy in spine surgery. Spine (Phila Pa 1976) 25:2663–2667
Daubs MD, Lenke LG, Cheh G, Stobbs G, Bridwell KH (2007) Adult spinal deformity surgery: complications and outcomes in patients over age 60. Spine (Phila Pa 1976) 32:2238–2244
Cloyd JM, Acosta FL Jr, Ames CP (2008) Complications and outcomes of lumbar spine surgery in elderly people: a review of the literature. J Am Geriatr Soc 56:1318–1327
Choi JM, Choi MK, Kim SB (2017) Perioperative results and complications after posterior lumbar interbody fusion for spinal stenosis in geriatric patients over than 70 years old. J Korean Neurosurg Soc 60:684–690
Ahn Y, Oh HK, Kim H, Lee SH, Lee HN (2014) Percutaneous endoscopic lumbar foraminotomy: an advanced surgical technique and clinical outcomes. Neurosurgery 75:124–133
Knight MT, Vajda A, Jakab GV, Awan S (1998) Endoscopic laser foraminoplasty on the lumbar spine--early experience. Minim Invasive Neurosurg 41:5–9
Hafez MI, Zhou S, Coombs RR, McCarthy ID (2001) The effect of irrigation on peak temperatures in nerve root, dura, and intervertebral disc during laser-assisted foraminoplasty. Lasers Surg Med 29:33–37
Yeung AT, Tsou PM (2002) Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases. Spine (Phila Pa 1976) 27:722–731
Knight M, Goswami A (2003) Management of isthmic spondylolisthesis with posterolateral endoscopic foraminal decompression. Spine (Phila Pa 1976) 28:573–581
Ahn Y, Lee U (2018) Use of lasers in minimally invasive spine surgery. Expert Rev Med Devices 15:423–433
Telfeian AE, Jasper GP, Francisco GM (2015) Transforaminal endoscopic treatment of lumbar radiculopathy after instrumented lumbar spine fusion. Pain Physician 18:179–184
Ahn Y, Lee SH, Park WM, Lee HY (2003) Posterolateral percutaneous endoscopic lumbar foraminotomy for L5-S1 foraminal or lateral exit zone stenosis. Technical note. J Neurosurg 99:320–323
Kim DY, Lee SH, Lee HY, Lee HJ, Chang SB, Chung SK, Kim HJ (2005) Validation of the Korean version of the Oswestry disability index. Spine (Phila Pa 1976) 30:E123–E127
Macnab I (1971) Negative disc exploration. An analysis of the causes of nerve-root involvement in sixty-eight patients. J Bone Joint Surg Am 53:891–903
Tsou PM, Yeung AT (2002) Transforaminal endoscopic decompression for radiculopathy secondary to intracanal noncontained lumbar disc herniations: outcome and technique. Spine J 2:41–48
Ng LC, Tafazal S, Sell P (2007) The effect of duration of symptoms on standard outcome measures in the surgical treatment of spinal stenosis. Eur Spine J 16:199–206
Ostelo RW, Deyo RA, Stratford P, Waddell G, Croft P, Von Korff M, Bouter LM, de Vet HC (2008) Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine (Phila Pa 1976) 33:90–94
Acosta FL Jr, McClendon J Jr, O'Shaughnessy BA, Koller H, Neal CJ, Meier O, Ames CP, Koski TR, Ondra SL (2011) Morbidity and mortality after spinal deformity surgery in patients 75 years and older: complications and predictive factors. J Neurosurg Spine 15:667–674
Kobayashi K, Imagama S, Ando K et al (2017) Risk factors for delirium after spine surgery in extremely elderly patients aged 80 years or older and review of the literature: Japan Association of Spine Surgeons with Ambition Multicenter Study. Global Spine J 7:560–566
Kobayashi K, Imagama S, Ando K et al (2017) Complications associated with spine surgery in patients aged 80 years or older: Japan Association of Spine Surgeons with ambition (JASA) Multicenter Study. Global Spine J 7:636–641
Hussain M, Berger M, Eckenhoff RG, Seitz DP (2014) General anesthetic and the risk of dementia in elderly patients: current insights. Clin Interv Aging 9:1619–1628
Zorrilla-Vaca A, Healy RJ, Mirski MA (2017) A comparison of regional versus general anesthesia for lumbar spine surgery: a meta-analysis of randomized studies. J Neurosurg Anesthesiol 29:415–425
Finsterwald M, Muster M, Farshad M, Saporito A, Brada M, Aguirre JA (2018) Spinal versus general anesthesia for lumbar spine surgery in high risk patients: perioperative hemodynamic stability, complications and costs. J Clin Anesth 46:3–7
Kim CT, Myung W, Lewis M et al (2018) Exposure to general anesthesia and risk of dementia: a nationwide population-based cohort study. J Alzheimers Dis 63:395–405
Schubert M, Hoogland T (2005) Endoscopic transforaminal nucleotomy with foraminoplasty for lumbar disk herniation. Oper Orthop Traumatol 17:641–661
Knight MT, Goswami A, Patko JT, Buxton N (2001) Endoscopic foraminoplasty: a prospective study on 250 consecutive patients with independent evaluation. J Clin Laser Med Surg 19:73–81
Acknowledgments
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.
Funding
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).
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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.
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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.
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The authors declare that they have no conflict of interest.
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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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Ahn, Y., Keum, H.J., Shin, S.H. et al. Laser-assisted endoscopic lumbar foraminotomy for failed back surgery syndrome in elderly patients. Lasers Med Sci 35, 121–129 (2020). https://doi.org/10.1007/s10103-019-02803-7
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DOI: https://doi.org/10.1007/s10103-019-02803-7