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Updated: Jun 27, 2026
A Mobile Outside-in Technique of Transforaminal Lumbar Endoscopy for Lumbar Disc Herniations
Published on: August 7, 2018
Percutaneous Endoscopic Decompression versus Non-Operative Care for Radicular Pain in the Oldest-Old with Lumbar
Miao Wang1, Qiong Wang2, Guang-Zhou Li1
1Department of Spine Surgery, Suining Central Hospital, Suining, 629000, People's Republic of China.
Objective:
To emulate a target trial comparing percutaneous transforaminal endoscopic decompression (PTED) versus non-operative care for older patients with unilateral radicular pain due to lumbar spinal stenosis (LSS), focusing on comprehensive treatment failure and deprescribing.
Design:
Retrospective cohort study using a Target Trial Emulation Framework.
Setting:
Single academic spine center.
Participants:
143 consecutive patients aged ≥80 years with unilateral radicular symptoms and imaging-confirmed LSS (February 2022-October 2024). All underwent confirmatory diagnostic nerve root block.
Interventions:
PTED under local anesthesia (n=75) versus structured non-operative care (n=68).
Main Outcome Measures:
Primary outcome was 90-day comprehensive treatment failure (unplanned rehospitalization or treatment escalation due to uncontrolled pain or serious complication). Secondary outcomes were Oswestry Disability Index (ODI) and polypharmacy at 12 months.
Results:
PTED group had significantly lower primary outcome incidence (16.0% vs 44.1%). After multivariable adjustment and inverse probability weighting, PTED was associated with markedly lower odds of comprehensive treatment failure (adjusted odds ratio [aOR] 0.18, 95% CI 0.07-0.47), primarily driven by pain-related failure (aOR 0.06; number needed to treat = 3.7). Complication-related failure did not differ significantly between groups, yielding a favorable benefit-risk ratio of 6.6:1. Subgroup analyses confirmed treatment effect consistency across key patient characteristics. At 12 months, PTED patients demonstrated greater ODI improvement (adjusted difference -8.92 points) and significantly lower polypharmacy prevalence (aOR 0.14), indicating sustained "deprescribing" benefit.
Conclusion:
In this emulated target trial, PTED was associated with reduced 90-day treatment failure and benefits at 12 months in pain relief and polypharmacy reduction among carefully selected oldest-old patients with LSS. These findings support PTED's potential in this population and justify the need for a prospective randomized trial.
