Age-dependent outcomes following transforaminal endoscopic lumbar discectomy

Transforaminal endoscopic lumbar discectomy (TELD) has expanded as a minimally invasive alternative for treating lumbar disc herniations, particularly in elderly patients due to reduced tissue disruption and avoidance of general anesthesia. However, factors influencing early clinical outcomes in this population remain poorly defined. The authors sought to evaluate predictors of early symptom resolution following TELD, with a focus on age-related effects.

A retrospective review was performed of consecutive patients undergoing TELD at a tertiary academic center between 2013 and 2022. The primary outcome was symptom resolution at 6 weeks postoperatively, defined as documented clinical improvement in radicular symptoms. Demographic and surgical variables were analyzed using univariate methods. A case-control MRI review was performed of all patients without symptom resolution and an equal number of randomly selected patients with symptom resolution. Foraminal stenosis, vertical foraminal stenosis, lateral recess stenosis, disc height loss, and facet hypertrophy were assessed at the operative level using established MRI grading systems. Multivariable logistic regression modeling was performed to identify independent predictors of lack of symptom resolution. Age was evaluated as both a continuous and a categorical variable to identify clinically relevant thresholds.

A total of 173 patients who underwent TELD were included, of whom 45 (26.0%) experienced no early symptom resolution. No significant differences were observed between groups with respect to foraminal stenosis, vertical foraminal stenosis, lateral recess stenosis, disc height loss, or facet hypertrophy. Increasing age was significantly associated with lower rates of symptom improvement (mean age 67.7 vs 62.1 years, p = 0.009). Patients aged ≥ 70 years demonstrated a higher rate of persistent symptoms compared with younger patients (33.9% vs 20.2%, p = 0.041). On multivariable analysis, increasing age remained independently associated with higher odds of no symptom resolution (OR 1.05 per year increase, 95% CI 1.01-1.09, p = 0.013), whereas sex, BMI, and MRI degenerative variables were not independently associated with outcome.

Older age is independently associated with reduced early symptom resolution following TELD. Although older patients demonstrate greater degenerative pathology on MRI, these imaging findings do not independently predict outcome. These findings suggest that age captures additional factors beyond conventional radiographic measures of degeneration and should be considered during patient selection and preoperative counseling.