Minimally Invasive Endoscopic Spine Surgery as a Viable Option for Geriatric Patients with High Anesthetic Risk

Spinal stenosis poses a significant healthcare challenge in the United States. This case report delineates the progressive interventions in a male over 90 years of age with lumbar spinal stenosis, emphasizing the shift toward minimally invasive endoscopic spine surgery. The patient, burdened by neurogenic claudication, failed conservative measures, leading to substantial pain and diminished quality of life. Traditional open spine surgery, fraught with morbidity and mortality risks, prompted consideration of alternative approaches. The case details the journey of the patient through various interventions, culminating in endoscopic decompression as opposed to more invasive open surgical methods. It is important to note that the patient was evaluated by colleagues in the facility's neurosurgical department and deemed not a candidate for surgery due to his age and comorbidities. The elderly patient with a complex medical history underwent a myriad of marginally effective treatments, prompting the ultimate intervention, a minimally invasive interlaminar endoscopic decompression. Postoperatively, the patient reported significant improvement in a subjective pain score based on 0 being no pain and 10 being debilitating pain, marking a paradigm shift from 10 out of 10 pain to an average of two out of 10. The discussion centers on the evolution from traditional open spine surgery to endoscopic procedures and factors to consider when deciding the appropriate therapy. The case underscores the favorable outcomes associated with endoscopic decompression and compares the recent literature to more traditional surgical operations. While acknowledging the limitations of endoscopic decompression, especially in challenging anatomical regions, the report emphasizes the promising role of endoscopic procedures, particularly in high-risk populations. The geriatric patient, refractory to conventional treatments, achieved excellent pain relief without reported sequelae from open surgical techniques.