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Updated: Apr 21, 2026
Author Spotlight: Scope of LE-ULBD as a Safe, Effective, and Minimally Invasive Approach to Treat Lumbar Spinal Stenosis
Published on: February 9, 2024
Targeted Decompression Under Local Anesthesia versus Extensive Decompression Under General Anesthesia for
Hang Zhang1, Huili Cai2, Yunzhong Cheng3
1Department of Spine Surgery, Yichang Central People's Hospital, First Clinical Medical College of China Three Gorges University, Yichang, Hubei, People's Republic of China.
Percutaneous endoscopic lumbar discectomy under local anesthesia (PELD-LA) offers comparable efficacy to general anesthesia (GA) endoscopic procedures for octogenarians. PELD-LA significantly reduces complications and speeds recovery in elderly patients with lumbar degenerative diseases.
Area of Science:
- Spine Surgery
- Geriatric Medicine
- Minimally Invasive Procedures
Background:
- Surgical management of lumbar degenerative diseases (LDD) in octogenarians presents challenges due to reduced physiological reserves.
- General anesthesia (GA)-based endoscopic techniques (ENDO-GA) can cause significant systemic stress in frail elderly patients.
- Percutaneous endoscopic lumbar discectomy under local anesthesia (PELD-LA) offers a less invasive alternative, mitigating GA-related risks.
Purpose of the Study:
- To evaluate the safety and efficacy of PELD-LA compared to ENDO-GA in octogenarian patients with LDD.
- To assess perioperative outcomes, including complications and recovery efficiency.
- To compare long-term clinical outcomes and patient satisfaction between the two surgical approaches.
Main Methods:
- Retrospective analysis of 100 octogenarians with LDD, stratified into PELD-LA (n=54) and ENDO-GA (n=46) groups.
- 1:1 Propensity Score Matching (PSM) was used to balance baseline characteristics (age, sex, comorbidities, ASA classification), resulting in 39 matched pairs.
- Primary outcomes included complications, PONV, ambulation time, and hospital stay; secondary outcomes included VAS, ODI, and MacNab criteria.
Main Results:
- PELD-LA demonstrated significantly shorter operative times, earlier ambulation, and reduced hospital stay compared to ENDO-GA.
- Both techniques achieved comparable long-term efficacy (MacNab criteria: 94.9% vs 94.9%), with PELD-LA showing superior early pain relief (VAS, ODI).
- The PELD-LA group had a significantly lower overall complication rate (30.8% vs 82.1%), notably reduced PONV (23.1% vs 66.7%).
Conclusions:
- PELD-LA provides comparable clinical efficacy to ENDO-GA in octogenarians for LDD, with significantly reduced perioperative complications and accelerated recovery.
- PELD-LA is a physiologically rational strategy for frail elderly patients, balancing targeted decompression with systemic stability.
- Tailored patient selection is crucial, highlighting PELD-LA as a valuable option for specific elderly populations undergoing lumbar spine surgery.
