A Retrospective Evaluation of the Clinical Success
of Transforaminal Endoscopic Discectomy with
Foraminotomy in Geriatric Patients

Background: The elderly population is growing in the United States. As the oldest old are projected to be the fastest growing part of the elderly population, we must consider how to best treat their degenerative spine conditions when non-operative treatment fails. Objectives: Transforaminal endoscopic discectomy and foraminotomy is an ultra-minimally invasive outpatient surgical option that does not require general anesthesia and is available to geriatric. The purpose of this study was to assess the benefit of transforaminal endoscopic discectomy and foraminotomy in geriatric patients with single level and multi-level lumbar disc herniations and lumbar radiculopathy. Study Design: Retrospective study Setting: Outpatient surgery center. Methods: After Institutional Review Board Approval, charts from 50 consecutive patients aged 75 and older with complaints of lower back and radicular pain who underwent one or more endoscopic procedures between 2007 and 2011 were reviewed. Results: The average pain relief 6 months postoperatively was reported to be 71.8%, good results as defined by MacNab. The average pre-operative VAS score was 9.04, indicated in our questionnaire as severe and constant pain. The average 6 month post-operative VAS score was 2.63, indicated in our questionnaire as mild and intermittent pain. Limitations: This is a retrospective study and only offers 6 month follow-up data for geriatric patients undergoing endoscopic spine surgery. Conclusions: Endoscopic discectomy is a safe and effective alternative to open back surgery. The 6-month follow-up data presented here appears to indicate that an ultra-minimally invasive approach to the geriatric spine that has a low complication rate, avoids general anesthesia, and is outpatient might be worth studying in a prospective, longer term way. IRB approval: Meridian Health: IRB Study # 201206071J Key words: Endoscopic discectomy, minimally invasive, transforaminal, geriatric

Download Full-text

Transforaminal Endoscopic Discectomy with Foraminoplasty for the Treatment of Spondylolisthesis

January 2018 - Pain Physician ◽

10.36076/ppj.2014/17/e703 ◽

2014 ◽

Vol 6;17 (6;12) ◽

pp. E703-E708 ◽

Cited By ~ 1

Author(s):

Albert E. Telfeian

Keyword(s):

Minimally Invasive ◽

General Anesthesia ◽

Degenerative Spondylolisthesis ◽

Lumbar Radiculopathy ◽

Invasive Approach ◽

Vas Score ◽

Constant Pain ◽

Endoscopic Discectomy ◽

One Year

Background: Lumbar degenerative spondylolisthesis is a common entity and occurs mainly in elderly patients. The trend in surgery has been to offer decompression with instrumented fusion based on patient-based outcome data and the inherent instability of the condition. Objectives: Transforaminal endoscopic discectomy and foraminotomy is an ultra-minimally invasive outpatient surgical option available to patients that does not require general anesthesia and does not involve the same amount of destabilizing facet joint removal as a traditional laminectomy and medial facetectomy. The purpose of this study was to assess the benefit of tranforaminal endoscopic discectomy and foraminotomy in patients with lumbar 4-5 (L4-L5) and lumbar 5-sacral 1 (L5-S1) spondylolisthesis and lumbar radiculopathy. Methods: After Institutional Review Board Approval, charts from 21 consecutive patients with L4-L5 or L5-S1 spondylolisthesis and complaints of lower back and radicular pain who underwent endoscopic procedures between 2007 and 2012 were reviewed. Results: The average pain relief one year postoperatively was reported to be 71.9%, good results as defined by MacNab. The average pre-operative VAS score was 8.48, indicated in our questionnaire as severe and constant pain. The average one year postoperative VAS score was 2.30, indicated in our questionnaire as mild and intermittent pain. Limitations: This is a retrospective study and only offers one year follow-up data for patients with spondylolisthesis undergoing endoscopic spine surgery for treatment of lumbar radiculopathy. Conclusions: Endoscopic discectomy is a safe and effective alternative to open back surgery. The one year follow-up data presented here appears to indicate that an ultra-minimally invasive approach to the treatment of lumbar radiculopathy in the setting of spondylolisthesis that has a low complication rate, avoids general anesthesia, and is outpatient might be worth studying in a prospective, longer term way. IRB approval: Meridian Health: IRB Study # 201206071J Key words: Endoscopic discectomy, minimally-invasive, transforaminal, spondylolisthesis

Download Full-text

Transforaminal Endoscopic Treatment of Lumbar Radiculopathy after Instrumented Lumbar Spine Fusion

January 2018 - Pain Physician ◽

10.36076/ppj/2015.18.179 ◽

2015 ◽

Vol 2;18 (2;3) ◽

pp. 179-184

Author(s):

Albert E. Telfeian

Keyword(s):

Retrospective Study ◽

Minimally Invasive ◽

Lumbar Fusion ◽

Herniated Disc ◽

Invasive Technique ◽

Lumbar Radiculopathy ◽

Vas Score ◽

Constant Pain ◽

Endoscopic Discectomy ◽

One Year

Background: Transforaminal endoscopic discectomy and foraminotomy is a well-described minimally invasive technique for surgically treating lumbar radiculopathy caused by a herniated disc and foraminal narrowing. Objective: To describe the technique and feasibility of transforaminal foraminoplasty for the treatment of lumbar radiculopathy in patients who have already undergone instrumented spinal fusion. Study Design: Retrospective study. Setting: Hospital and ambulatory surgery center Methods: After Institutional Review Board approval, charts from 18 consecutive patients with lumbar radiculopathy and instrumented spinal fusions who underwent endoscopic procedures between 2008 and 2013 were reviewed. Results: The average pain relief one year postoperatively was reported to be 67.0%, good results as defined by MacNab. The average preoperative VAS score was 9.14, indicated in our questionnaire as severe and constant pain. The average one year postoperative VAS score was 3.00, indicated in our questionnaire as mild and intermittent pain. Limitations: This is a retrospective study and only offers one year follow-up data for patients with instrumented fusions who have undergone endoscopic spine surgery. Conclusion: Transforaminal endoscopic discectomy and foraminotomy could be used as a safe, yet, minimally invasive and innovative technique for the treatment of lumbar radiculopathy in the setting of previous instrumented lumbar fusion. IRB approval: Meridian Health: IRB Study # 201206071J Key words: Endoscopic siscectomy, minimally-invasive, transforaminal, fusion

Download Full-text

Microendoscopic decompression for cervical spondylotic myelopathy

Neurosurgical FOCUS ◽

10.3171/2013.3.focus135 ◽

2013 ◽

Vol 35 (1) ◽

pp. E8 ◽

Cited By ~ 22

Author(s):

Nader S. Dahdaleh ◽

Albert P. Wong ◽

Zachary A. Smith ◽

Ricky H. Wong ◽

Sandi K. Lam ◽

...

Keyword(s):

Spinal Cord ◽

Retrospective Study ◽

Cobb Angle ◽

Cervical Spondylotic Myelopathy ◽

Elderly Population ◽

The Elderly ◽

The Mean ◽

Spinal Cord Decompression ◽

Cervical Degenerative Disease

Object Cervical spondylotic myelopathy (CSM) is a common cervical degenerative disease that affects the elderly population. Spinal cord decompression is achieved through various anterior and posterior approaches including anterior cervical decompression and fusion, laminectomy, laminoplasty, and combined approaches. The authors describe another option, minimally invasive endoscopically assisted decompression of stenosis (MEDS), which obviates the need for muscle dissection and disruption of the posterior tension band, a cause of postlaminectomy kyphosis. Methods The authors conducted a retrospective study of 10 patients with CSM who underwent MEDS from January 2002 through July 2012. Data were collected on demographics, preoperative and postoperative Nurick scores, postoperative Odom scores, and preoperative and postoperative Cobb angles. Results The mean patient age (± SD) was 67 ± 7.7 years; 8 patients were male. The average number of disc levels operated on was 2.2 (range 1–4). The mean Nurick score was 1.6 ± 0.7 preoperatively and improved to 0.3 ± 0.7 postoperatively (p < 0.0005). The postoperative Odom scores indicated excellent outcomes for 4 patients, good for 3, fair for 2, and poor for 1. The average preoperative focal Cobb angle at the disc levels operated on was −0.43º ± 1.9º. The average Cobb angle at the last follow-up visit was 0.25° ± 1.6° (p = 0.6). The average follow-up time was 18.9 ± 32.1 months. There were no intraoperative or postoperative complications. Conclusions For selected patients with CSM, whose pathologic changes are primarily posterior and who have acceptable preoperative lordosis, MEDS is an alternative to open laminectomy and laminoplasty.

Download Full-text

Considerations for a Respiratory Syncytial Virus Vaccine Targeting an Elderly Population

Vaccines ◽

10.3390/vaccines9060624 ◽

2021 ◽

Vol 9 (6) ◽

pp. 624

Author(s):

Laura M. Stephens ◽

Steven M. Varga

Keyword(s):

Respiratory Syncytial Virus ◽

Disease Burden ◽

Elderly Population ◽

Vaccine Development ◽

The Elderly ◽

The United States ◽

Susceptible Population ◽

Age Related ◽

Syncytial Virus ◽

Tract Infections

Respiratory syncytial virus (RSV) is most commonly associated with acute lower respiratory tract infections in infants and children. However, RSV also causes a high disease burden in the elderly that is often under recognized. Adults >65 years of age account for an estimated 80,000 RSV-associated hospitalizations and 14,000 deaths in the United States annually. RSV infection in aged individuals can result in more severe disease symptoms including pneumonia and bronchiolitis. Given the large disease burden caused by RSV in the aged, this population remains an important target for vaccine development. Aging results in lowered immune responsiveness characterized by impairments in both innate and adaptive immunity. This immune senescence poses a challenge when developing a vaccine targeting elderly individuals. An RSV vaccine tailored towards an elderly population will need to maximize the immune response elicited in order to overcome age-related defects in the immune system. In this article, we review the hurdles that must be overcome to successfully develop an RSV vaccine for use in the elderly, and discuss the vaccine candidates currently being tested in this highly susceptible population.

Download Full-text

Application of a Targeted and Quantificational Foraminoplasty Device in Percutaneous Transforaminal Endoscopic Discectomy for L5-S1 Disc Herniation: Preliminary Clinical Outcomes

10.21203/rs.3.rs-356813/v1 ◽

2021 ◽

Author(s):

Jinlong Liu ◽

Junlong wu ◽

Honglei Zhang ◽

Rui Zuo ◽

Jiabin Liu ◽

...

Keyword(s):

Leg Pain ◽

Fluoroscopy Time ◽

Low Back ◽

Disk Herniation ◽

Lumbar Disk Herniation ◽

Lumbar Disk ◽

Vas Score ◽

Endoscopic Discectomy ◽

Percutaneous Transforaminal Endoscopic Discectomy

Abstract ObjectivePercutaneous transforaminal endoscopic discectomy (PTED) is minimally invasive and has been widely used to treat patients with lumbar disk herniation(LDH) due to its safety and efficiency. However, due to the unique anatomy of the L5-S1 level, the PTED procedure is often difficult to perform in the region. ZESSYS, a targeted and quantificational foraminoplasty device, may help to overcome these anatomical limitations. In this study, we assessed the efficiency and the short-term eﬀects of PTED with ZESSY at the L5-S1 level.MethodsBetween January to August of 2018, Fifty-six patients with lumbar disk herniation at the single level of L5–S1 and underwent percutaneous transforaminal endoscopic discectomy were enrolled in this retrospective cohort study. They were segregated into the the TESSYS group and the ZESSYS group. The puncture time, foraminoplasty time, decompression time and fluoroscopy time evaluated for the operation efficiency. Clinical outcomes were assessed by visual analog scale(VAS) score and Oswestry Disability Index(ODI) score. The MacNab criteria were used to evaluate patient subjective satisfaction at 12-month follow-up postoperatively.ResultsThe average puncture time (5.29±2.05 minutes), foraminoplasty time (12.82±2.52 minutes) and fluoroscopy time (26.29±5.96 seconds) were all significantly shorter in the ZESSYS group than in the TESSYS group (average puncture time 8.07±3.13 minutes, p<0.01; foraminoplasty time, 17.18±2.92 minutes, p<0.01; fluoroscopy time, 34.73±6.86 seconds; p<0.01). No significant differences were observed between the 2 groups in the decompression time (p=0.057). The VAS score of low back pain and leg pain, as well as the ODI score, improved at all time points postoperatively compared with preoprative , in both the TESSYS group and the ZESSYS group (P < 0.05). There were no significant differences in the VAS score of low back pain, VAS score of leg pain, and ODI score between the TESSYS group and the ZESSYS group at the same time points (P > 0.05). According to the MacNab criteria, the excellent and good rate at 12-month follow-up postoperatively was 85.7% in the TESSYS group and 89.3% in the ZESSYS group (P > 0.05).ConclusionThe targeted and quantificational foraminoplasty device named ZESSYS was more efficient in the puncture and foraminoplasty procedures, effectively protecting the exiting nerve and minimizing the level of radiation exposure. The device is efficient and safe for PTED in treating lumbar disk herniation at the L5-S1 level.

Download Full-text

Minimally invasive comprehensive treatment for granulomatous lobular mastitis

10.21203/rs.2.16905/v2 ◽

2020 ◽

Author(s):

Yaohuai Wang ◽

Junlong Song ◽

Yi Tu ◽

Chuang Chen ◽

Shengrong Sun

Keyword(s):

Retrospective Study ◽

Minimally Invasive ◽

Operative Technique ◽

Treatment Process ◽

Comprehensive Treatment ◽

The Past ◽

Image Characteristics ◽

Surgical History ◽

Hospital Stays

Abstract Objective: To describe a minimally invasive comprehensive treatment for granulomatous lobular mastitis (GLM) and compare its effect with the existing methods, particularly in terms of its recurrence rate and esthetic outcomes. Methods: This retrospective study reviewed 69 GLM patients receiving the minimally invasive comprehensive treatment. Patients’ information, including age, clinical features, image characteristics, histopathological findings, mastitis history, treatment process, operative technique, recurrence, and esthetic effect, was evaluated. Results: All patients were female with a median age of 32 (range 17 - 55) years. Hospital stays ranged from 2 to 34 days, with a median of 6 days. The shortest time for complete rehabilitation was 2 days and the longest time was 365 days, with a median of 30 days. After a median follow-up of 391 days (range 162 - 690), 7 patients (10.14%) relapsed. The average cosmetic score was 2.62 ± 0.57 points and was mainly related to the past treatment, especially the surgical history. Conclusion: Minimally invasive comprehensive treatment is a new method for the treatment of GLM, ensuring a therapeutic effect while maintaining breast beauty.

Download Full-text

Prevalence and comparison of depression rates in geriatric patients of old age home and community, and its association with chosen demographic factors

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20201923 ◽

2020 ◽

Vol 8 (5) ◽

pp. 1760

Author(s):

Preksha T. Singh ◽

Shreyans D. Singhvi ◽

Gautam Bhandari

Keyword(s):

Old Age ◽

Elderly Population ◽

Geriatric Patients ◽

Geriatric Depression Scale ◽

Depression Scale ◽

Demographic Factors ◽

Educational Status ◽

The Elderly ◽

Health Condition ◽

Geriatric Depression

Background: Depression is an emerging mental health condition and elderly population of the world is often affected by it. In the elderly, it often goes unnoticed and often burdens them.Methods: Two groups of population one from an old age home and the other from a community were selected. Data was collected using a Geriatric Depression Scale (GDS) and a demographic form. The data was compiled and analyzed using Google Spreadsheets.Results: Depression rates were found in both, the old age home and the community. The rates were found higher in the old age home than the community. The demographic factors chronic illness, gender, educational status and marital status were found to be associated with depression.Conclusions: As depression in elderly is a fairly common phenomenon, it should be paid more attention. The elderly should receive intervention for the disease and be able to sustain it.

Download Full-text

Livestock production and antibiotic resistant pneumonia in the elderly population of the United States

Annals of Global Health ◽

10.1016/j.aogh.2015.02.758 ◽

2015 ◽

Vol 81 (1) ◽

pp. 111

Author(s):

K. Howell ◽

G.A. Beresin ◽

G. Jeffries ◽

A. Liss ◽

E. Naumova

Keyword(s):

United States ◽

Elderly Population ◽

The Elderly ◽

The United States ◽

Livestock Production ◽

Antibiotic Resistant

Download Full-text

The Geriatric Patient

10.2310/anes.18146 ◽

2019 ◽

Author(s):

Maggie Mechlin ◽

Peter Arrabal

Keyword(s):

Risk Stratification ◽

Elderly Population ◽

Geriatric Patients ◽

The Elderly ◽

Medical Procedures ◽

Compassionate Care ◽

Code Status ◽

Cognitive Evaluation ◽

Organ Systems ◽

Postoperative Cognitive Decline

An aging population combined with the increasing availability of invasive medical procedures has created a growing number of elderly patients that anesthesiologists care for every day. Geriatric patients present unique challenges that must be taken into consideration when crafting an anesthetic plan. To start with, one must first decide what it means to be elderly. Is it an age cutoff? If so, at what age does a patient become elderly? Is it a physiologic definition? If so, what amount of physiologic derangement must be present and in how many organ systems for someone to be classified as elderly? Although there is no clear consensus, a reasonable definition would combine age with the patient’s physical tolerance towards the stresses of surgery. This chapter attempts to address the myriad challenges faced by the perioperative physician who is planning to anesthetize an elderly patient. There are unique points to be noted in the preoperative physical examination, cognitive evaluation, creation of the anesthetic plan, and risk stratification. There are additional concerns related to a patient’s wishes regarding code status and potential end-of-life care. By addressing all these issues, anesthesiologists can provide safe, successful, and compassionate care to a complex and diverse elderly population. This review contains 5 figures, 3 tables, and 52 references. Key Words: anesthetizing the elderly, code status discussion, delirium, pharmacokinetic changes of aging, postoperative cognitive decline, physiologic changes of aging, regional anesthesia for orthopedic surgery, risk stratification

Download Full-text

Is cemented revision total hip arthroplasty a reasonable treatment option in an elderly population?

Orthopedic Reviews ◽

10.4081/or.2019.8263 ◽

2019 ◽

Vol 11 (3) ◽

Author(s):

Philipp Born ◽

Isabella Manzoni ◽

Thomas Ilchmann ◽

Martin Clauss

Keyword(s):

Aseptic Loosening ◽

Elderly Population ◽

Weight Bearing ◽

The Elderly ◽

Full Weight Bearing ◽

Septic Loosening ◽

Term Survival ◽

Press Fit ◽

Revision Tha

Revision THA is increasingly performed especially in the elderly population. The surgeon’s challenge is to provide a solution that supports immediate full weight-bearing, despite poor bone quality. Shape-closed revision stems facilitate that by combining cement fixation with additional press-fit anchoring. The design tolerates varying cement mantle thickness and inconsistent cancellous bone lining of the femoral canal. Following that philosophy, we present our mid-term results using a long version of a cemented Charnley- Kerboull type stem. From 2010 to 2017, 38 long Charnley-Kerboull revision stems (Centris®, Mathys European Orthopaedics, Bettlach, Switzerland) were implanted and followed prospectively. Surgery was performed via a Hardinge approach in supine position with a third generation cementing technique. Patients were mobilized using full-weight bearing as early as possible. Survival was determined for stem revision for aseptic loosening and stem and/or cup revision for any reason. 20 stems had a minimum follow-up (f/u) of 2 years and were included for further radiological analysis. Detailed subsidence analysis as an early predictor for later aseptic loosening was performed using EBRA-FCA software. Further, the presence of osteolysis and cement debonding was evaluated. Mean follow- up was 4 years. No patient was lost to f/u.18 died of causes unrelated to THA. Stem survival was 100%. Survival for any re-operation was 82.2% (two early infections, one soft-tissue debridement, one cup exchange for recurrent dislocations). None of the cases revised for septic loosening showed signs of persistent infection at final f/u. EBRA-FCA revealed two oligosymptomatic cases of subsidence of 5mm and 6mm over a course of 2 and 12 months, respectively, with stable implants thereafter. Neither required revision. There was no development of osteolysis or debonding. The stem provides a reliable early fullweight bearing solution for revision THA with excellent mid-term survival in an elderly population. Even in two cases where subsidence was present, mobility was not impaired and re-revision could be avoided.

Download Full-text