Comparison of percutaneous transforaminal endoscopic decompression and posterior lumbar interbody fusion for geriatric patients with degenerative lumbar scoliosis and spinal stenosis

Abstract

The optimal surgical strategy for geriatric patients with mild degenerative lumbar scoliosis (DLS) and lumbar spinal stenosis (LSS) remains controversial. Although percutaneous transforaminal endoscopic decompression (PTED) offers the advantages of minimal invasiveness, some older patients present with degenerative and stenotic features that may favor posterior lumbar interbody fusion (PLIF). This single-center retrospective study included geriatric patients (≥ 70 years) with DLS and LSS who underwent surgery between January 2016 and March 2023. Patients were divided into two groups based on the surgical approach: the PTED and PLIF groups. Clinical outcomes were assessed using the Oswestry Disability Index (ODI) and visual analog scale (VAS) preoperatively and at 3 months, 1 year, and 2 years after surgery. Patient satisfaction was assessed using the modified MacNab criteria. Radiological evaluations included measurements of the Cobb angle, lumbar lordosis, segmental coronal angle, and disc height. Additionally, complications and radiographic adjacent segment degeneration were recorded. A total of 68 geriatric patients (42 in the PTED group and 26 in the PLIF group) were included in this study. The baseline demographic and radiological characteristics were comparable between the PLIF and PTED groups. Similarly, both surgical techniques significantly improved postoperative clinical outcomes. However, compared to the PTED group, the PLIF group showed significantly lower VAS scores for back pain at 3 months, 1 year, and 2 years, along with lower leg pain VAS and ODI scores at 2 years ( P < 0.05 for all). The satisfaction rates were comparable between the PLIF and PTED groups (88.46% vs. 80.95%, P = 0.632). Radiologically, the PLIF group showed significant improvement in the Cobb angle, segmental coronal angle, and surgical-level disc height ( P < 0.05) and a significant decrease in adjacent-level disc height. Additionally, the PTED group experienced significantly shorter operation time and less intraoperative blood loss ( P < 0.001). Furthermore, the complication rates, both major and minor, were slightly higher in the PLIF group without statistical differences. No significant differences in recurrence and revision rates were observed between the two groups. PLIF was associated with superior radiographic outcomes and statistically better clinical outcomes, whereas PTED showed advantages in perioperative safety including shorter operative time, less blood loss, and fewer complications. Both procedures have distinct advantages, and surgical selection should be individualized based on patient characteristics and surgical risk.