1. 2013;16;225-229A Retrospective Evaluation of the Clinical Success of Transforaminal Endoscopic Discectomy with Foraminotomy in Geriatric Patients
   Retrospective Study
   Gabriele P Jasper, MD, Gina M Francisco, BSc, and Albert E Telfeian, MD, PhD.

BACKGROUND: The elderly population is growing in the United States. As the oldest old are projected to be the fastest growing part of the elderly population, we must consider how to best treat their degenerative spine conditions when non-operative treatment fails.

OBJECTIVES: Transforaminal endoscopic discectomy and foraminotomy is an ultra-minimally invasive outpatient surgical option that does not require general anesthesia and is available to geriatric. The purpose of this study was to assess the benefit of transforaminal endoscopic discectomy and foraminotomy in geriatric patients with single level and multi-level lumbar disc herniations and lumbar radiculopathy.

STUDY DESIGN: Retrospective study

SETTING: Outpatient surgery center.

METHODS: After Institutional Review Board Approval, charts from 50 consecutive patients aged 75 and older with complaints of lower back and radicular pain who underwent one or more endoscopic procedures between 2007 and 2011 were reviewed.

RESULTS: The average pain relief 6 months postoperatively was reported to be 71.8%, good results as defined by MacNab. The average pre-operative VAS score was 9.04, indicated in our questionnaire as severe and constant pain. The average 6 month post-operative VAS score was 2.63, indicated in our questionnaire as mild and intermittent pain.

LIMITATIONS: This is a retrospective study and only offers 6 month follow-up data for geriatric patients undergoing endoscopic spine surgery.

CONCLUSIONS: Endoscopic discectomy is a safe and effective alternative to open back surgery. The 6-month follow-up data presented here appears to indicate that an ultra-minimally invasive approach to the geriatric spine that has a low complication rate, avoids general anesthesia, and is outpatient might be worth studying in a prospective, longer term way.

IRB approval: Meridian Health: IRB Study # 201206071J