Percutaneous unilateral biportal endoscopic discectomy for symptomatic lumbar disc herniation in geriatric patients

Purpose: The purpose of this study is to investigate the surgical efficacy and safety of percutaneous unilateral biportal endoscopic discectomy (UBED) for symptomatic lumbar disc herniation (LDH) in geriatric patients. Methods: 72 geriatric patients with single or two-level LDH who underwent UBED from January 2020 to September 2022 were retrospectively analyzed. Ages of them ranged from 65 to 86 years (mean 73.2 years). Clinical outcomes were evaluated by operation time, total blood loss, hospital stay, visual analogue scale (VAS) score for leg pain, the Oswestry disability index (ODI) score, modified Macnab criteria and postoperative magnetic resonance imaging (MRI). Results: Surgery was successfully treated in all geriatri patients with an mean operation time of 46 minutes (range: 32-68 minutes). All patients were followed up for a average duration of 14.2 +/- 1.9 months (range: 12-16 months). The leg pain VAS score was decreased from 8.37 +/- 1.21 preoperatively to 2.03 +/- 0.61, 1.56 +/- 0.32, 1.16 +/- 0.45 and 0.91 +/- 0.26 at immediately after surgery and 1, 6, 12 months postoperatively. The ODI score was also dropped from 61.21 +/- 11.06 preoperatively to 27.52 +/- 10.41, 19.12 +/- 7.05, 12.17 +/- 5.21 and 8.56 +/- 4.32 at immediately after surgery and 1, 6, 12 months postoperatively. Significantly statistical difference was observed in both VAS and ODI score at each follow-up time point when compared with the preoperative parameters (P<0.01). And there were 53 excellent cases, 12 good cases and 7 fair cases based on the modified MacNab criteria at 12 months postoperatively, with an excellent and good rate of 90.2%. Only 2 cases were found complicated with low extremity numbness, which were recovered via conservative treatment in three weeks. No infection or iatrogenic neurological deficit was occured in all patients. Conclusions: We considered that UBED achieved satisfactory results and provided a minimally invasive, effective and safe alternative for the treatment of symptomatic LDH in geriatric patients.