Comparison of Effects of PELD and Fenestration in the Treatment of Geriatric Lumbar Lateral Recess Stenosis

Figures & data

Table 1 Patient Demographics and Operative Characteristics in PELD Group and Fenestration Group

Characteristic	PELD	Fenestration	p
Age (y), mean (range)	82.7 (75–93)	79.1 (75–88)	0.435
Gender (n/%)			0.894
Female	10 (43.5)	10 (45.5)
Male	13 (56.5)	12 (54.5)
BMI	23.2±4.2	25.4±5.3	0.593
Operative level			0.699
L3/4	2	1
L4/5	12	14
L5/S1	9	7
Comorbid diseases (n/%)
Hypertension	13 (56.5)	10 (45.5)
Diabetes mellitus	5 (21.7)	6 (27.3)
Heart disease	8 (34.8)	6 (27.3)
Cerebrovascular infarction	2 (8.7)	3 (13.6)
Respiratory diseases	4 (17.4)	2 (9.1)
Renal/Ureteral disease	3 (13.0)	2 (9.1)
Peripheral vascular disease	2 (8.7)	2 (9.1)
Neoplasia	2 (8.7)	1 (4.5)
Anxiety neurosis	1 (4.3)	0 (0.0)
Mean number of comorbid diseases	1.7	1.5

Table 2 General Clinical Results in the PELD Group and Fenestration Group

Outcome Measure	PELD (n=23), Mean (Range)	Fenestration (n=22), Mean (Range)	p
Operative time (min)	65.7 (45.0–85.0)	61.8 (50.0–75.0)	0.196
Bleeding quantity (mL)	48.3 (40.0–60.0)	128.2 (95.0–150.0)	<0.05
Length of stay (d)	2.2 (1.0–3.0)	4.3 (3.0–6.0)	<0.05
Hours until ambulation (h)	5.5 (2.0–12.0)	25.2 (20.0–38.0)	<0.05

Figure 1 Clinical outcomes before and after endoscopic decompression at different follow-up time points in PELD group and fenestration group. (A) Visual analog scale (VAS) scores for back pain. (B) VAS scores for leg pain. (C) Japanese Orthopaedic Association Score (JOA) scores.

Figure 2 Outcomes of 36-Item Short-Form Health Survey (SF-36) before and at the final follow-up.

Abbreviations: PF, physical functioning; RP, role-physical; BP, bodily pain; GH, general health; VT, vitality; SF, social functioning; RE, role emotional; MH, mental health; HT, health transitions.

Figure 3 Satisfaction rates according to the modified Macnab criteria in PELD group (A) and fenestration group (B) at the final review (18 months) post-surgery.

Figure 4 An 81-year-old female patient with lumbar lateral recess stenosis (LRS) who received PELD. (A) Preoperative magnetic resonance images (MRI) showing severe lateral recess stenosis with LRS at the left L4-5 level (yellow arrowhead). (B) Postoperative MRI showing a thorough nerve decompression (yellow arrowhead).

Figure 5 A 76-year-old male patient with lumbar lateral recess stenosis (LRS) who received fenestration. (A) Preoperative computed tomography (CT) images showing severe lateral recess stenosis with LRS at the left L4-5 level (yellow arrowhead). (B) Postoperative CT images showing a thorough nerve decompression (yellow arrowhead).

Table 3 Comparison of Clinical Results in PELD Group and Fenestration Group with Other Conventional Open Decompression Surgery for Lumbar Stenosis

Ref	Year of Publication	No./Av. Age of Patients	Av. Follow-Up Period	Success/Satisfaction Rate	Revision Surgery	Complications
Shabat S et al^Citation22	2008	39/83.95 years (range 80–91)	36.8 months	76%	4% (1)	6 urinary retention; 5 UTI; 3 bronchospasm; 2 delirium; 2 wound infection; 2 PAF; 2 depression; 1 CVA
Ragab AA et al^Citation23	2003	118/74 years (range 70–101)	7 years	92.4%	5.1% (6)	8 dural tears; 5 confusion; 4 hypotension; 1 dehiscence 2 urinary retention; 1 ileus 2 wound infection; 1 pseudogout
Jolles BM et al^Citation24	2001	77/61 years (range 25–85)	6.5 years	79%	Unreported	6 increased motor deficits; 2 increased sensory deficits; sphincter disturbance; 1 dural leak; 1 superficial wound infection
Cornefjord M et al^Citation25	2000	124/64.4 years (range 29–87)	7.1 years	65%	3.5% (3)	1 cauda equina syndrome 1 instability; 2 dural tears; 4 wound infections
Sanderson PL et al^Citation26	1993	34/72.2 years (range 65–81).	3.5 years	81%	Unreported	3 deep venous thromboses; 1 confusion
Current study PELD		23/82.7 years (range 75–93).	18 months	82.6%	0%	1 dural tear
Current study Fenestration		22/79.1 years (range 75–88).	18 months	86.4%	0%	1 dural tear; 2 postoperative delirium

Abbreviation: UTI, urinary tract infections; CVA, cerebrovascular accident; PAF, paroxysmal atrial fibrillation.

Shabat S, Arinzon Z, Folman Y, et al. Long-term outcome of decompressive surgery for lumbar spinal stenosis in octogenarians. Eur Spine J. 2008;17(2):193–198. doi:10.1007/s00586-007-0514-817940811

 PubMed Web of Science ®Google Scholar

Ragab AA, Fye MA, Bohlman HH. Surgery of the lumbar spine for spinal stenosis in 118 patients 70 years of age or older. Spine (Phila Pa 1976). 2003;28(4):348–353. doi:10.1097/01.BRS.0000048494.66599.DF12590208

 PubMed Web of Science ®Google Scholar

Jolles BM, Porchet F, Theumann N. Surgical treatment of lumbar spinal stenosis. Five-year follow-up. J Bone Joint Surg Br. 2001;83(7):949–953. doi:10.1302/0301-620X.83B7.083094911603533

 PubMedGoogle Scholar

Cornefjord M, Byrod G, Brisby H, et al. A long-term (4- to 12-year) follow-up study of surgical treatment of lumbar spinal stenosis. Eur Spine J. 2000;9(6):563–570. doi:10.1007/s00586000016111189928

 PubMed Web of Science ®Google Scholar

Sanderson PL, Wood PL. Surgery for lumbar spinal stenosis in old people. J Bone Joint Surg Br. 1993;75(3):393–397. doi:10.1302/0301-620X.75B3.84962068496206

 PubMedGoogle Scholar