Awake Unilateral Biportal Endoscopic Decompression Under Local Anesthesia for Degenerative Lumbar Spinal Stenosis in the Elderly: A Feasibility Study with Technique Note

Abstract

Purpose

Here, we introduce a novel strategy of awake unilateral biportal endoscopic (UBE) decompression, which applies conscious sedation combined with stepwise local anesthesia (LA) as an alternative to general anesthesia (GA). The study aims to evaluate the feasibility of awake UBE decompression for degenerative lumbar spinal stenosis (DLSS) in elderly patients.

Patients and Methods

This retrospective study included 31 consecutive patients who received awake UBE decompression for DLSS in our institution from January 2021 to March 2022. Clinical results were evaluated using patient-reported outcomes measures (PROM) including visual analog scale for leg pain (VAS-LP), Oswestry Disability Index (ODI), and modified MacNab criteria. The anesthesia effectiveness and intraoperative experience were evaluated by intraoperative VAS and satisfaction rating system.

Results

UBE decompression was successfully performed in all patients under LA combined with conscious sedation. 26 (83.9%) patients rated the intraoperative experience as satisfactory (excellent or good) and 5 (16.1%) as fair. The mean intraoperative VAS was 3.41±1.26. The VAS and ODI at each follow-up stage after surgery were significantly improved compared to preoperative scores (p < 0.01). At the last follow-up, 28 patients (90.3%) classified the surgical outcome as good or excellent, and 3 (9.7%) as fair. There were no serious complications or adverse reactions observed in the study.

Conclusion

Our preliminary results suggest that awake UBE decompression is a feasible and promising alternative for elderly patients with DLSS.

Keywords:

• awake spinal surgery
• local anesthesia
• degenerative lumbar disease
• biportal endoscopic spine surgery
• enhanced recovery after surgery

Abbreviations

UBE, unilateral biportal endoscopy; LA, local anesthesia; GA, general anesthesia; DLSS, degenerative lumbar spinal stenosis; PROM, patient-reported outcomes measures; VAS, visual analog scale; ODI, Oswestry disability index; ASS, awake spinal surgery; ULBD, unilateral laminotomy for bilateral decompression; PONV, postoperative nausea and vomiting; POD, postoperative delirium; ICH, intracranial hypertension; CT, computed tomography; MRI, magnetic resonance imaging.

Ethics Approval and Informed Consent

This study was approved by the ethics committee of Shengjing Hospital of China Medical University (2023PS854K), and the patient’s informed consent form was exempted, given the retrospective observational nature. This study was conducted in accordance with the Declaration of Helsinki.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This work was supported by grants from the Liaoning Province Key Research and Development Project (JH2/202, 1686036606770), 345 Talent Project and Outstanding Scientific Fund of Shengjing Hospital. The funders had no role in in any of the stages from study design to submission of the paper for publication.