ArticleClinical interventions in aging2026
Targeted Decompression Under Local Anesthesia versus Extensive Decompression Under General Anesthesia for Octogenarians with Lumbar Degenerative Diseases: A Real-World Propensity Score-Matched Analysis.
Article in Clinical interventions in aging, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Surgical management of lumbar degenerative diseases (LDD) in octogenarians requires balancing effective neural decompression against diminishing physiological reserves. While general anesthesia (GA)-based endoscopic techniques (ENDO-GA) are highly effective, they often impose excessive systemic stress on frail patients. Conversely, percutaneous endoscopic lumbar discectomy under local anesthesia (PELD-LA) provides targeted decompression while mitigating these GA-associated risks. Given the scarcity of direct comparisons in this fragile population, this study evaluates the safety and efficacy of PELD-LA versus ENDO-GA. Methods: We retrospectively analyzed 100 consecutive octogenarians treated for LDD between January 2021 and December 2024. Patients were stratified into two specific surgical strategy groups: targeted decompression via PELD-LA (n=54) and extensive decompression via ENDO-GA (utilizing UBE or Delta techniques, n=46). To minimize selection bias, a 1:1 Propensity Score Matching (PSM) was conducted using specific covariates (age, sex, comorbidities, and ASA classification), yielding 39 matched pairs (n=78). Primary outcomes assessed perioperative safety and recovery efficiency (complications, PONV, ambulation time, and length of hospital stay).Secondary outcomes evaluated postoperative clinical efficacy (VAS and ODI at 3 months, and modified MacNab criteria at 12 months postoperatively). Results: After propensity score matching, baseline characteristics were well-balanced between the two groups. Perioperatively, the PELD-LA group exhibited significantly shorter operative times (97 vs 150 min, P<0.001), earlier ambulation (48 vs 72 h, P<0.001), and reduced length of hospital stay (9 vs 14 days, P<0.001) compared to the ENDO-GA group. Clinically, despite a smaller "targeted" decompression range, PELD-LA achieved long-term efficacy (MacNab criteria: 94.9% vs 94.9%, P=1.000) comparable to extensive decompression, while demonstrating superior early pain relief and functional improvement (VAS and ODI) at 3 months postoperatively (P<0.01). Crucially, the overall complication rate was significantly lower in the PELD-LA group (30.8% vs 82.1%, P<0.001), primarily driven by a marked reduction in postoperative nausea and vomiting (PONV) (23.1% vs 66.7%, P<0.001). Conclusion: Within our short-to-medium-term observation period, PELD-LA delivered clinical efficacy comparable to GA-based endoscopic procedures for octogenarians, while significantly reducing perioperative complications and accelerating recovery. Crucially, we do not assert that PELD-LA is universally superior; rather, we emphasize the importance of tailored patient selection. For frail patients with limited physiological reserve, PELD-LA serves as a physiologically rational strategy, balancing targeted decompression with the preservation of systemic stability.
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