Safety and Efficacy of Percutaneous Transforaminal Endoscopic Decompression Under Local Anesthesia in Frail Elderly Patients with Severe Lumbar Spinal Stenosis

Objective: To evaluate the safety and efficacy of percutaneous transforaminal endoscopic decompression (PTED) under local anesthesia in frail elderly patients (≥ 75 years) with severe lumbar spinal stenosis (LSS).Methods: Forty-one patients (mean age: 82.4 ± 4.2 years) with severe central LSS (MRI grade ≥ 3), lateral recess stenosis (grade II in 38 cases), advanced disc degeneration (Pfirrmann IV–V), and frailty (score ≥ 3) underwent unilateral PTED. Outcomes included operative time, hospitalization duration, clinical metrics (VAS, ODI, Barthel Index), radiological improvements (dural sac cross-sectional area [DSCA], stenosis grading), and complications.Results: Mean operative time was 100.6 ± 19.2 minutes, with a postoperative hospital stay of 3.85 ± 1.21 days. At final follow-up (20.1 ± 4.2 months), significant improvements were observed: VAS back pain decreased from 3.65 ± 0.48 to 2.43 ± 0.50 ( p  < 0.01), VAS leg pain from 6.51 ± 0.50 to 2.07 ± 0.41 ( p  < 0.001), ODI from 67.2 ± 8.1 to 26.7 ± 6.9 ( p  < 0.001), and Barthel Index from 54.2 ± 8.2 (moderate disability) to 77.8 ± 6.12 (near independence) ( p  < 0.001). Radiologically, the dural sac cross-sectional area (DSCA) increased from 53.5 ± 21.2 mm² preoperatively to 70.8 ± 25.1 mm² postoperatively ( p  < 0.001). Lateral recess stenosis resolved in 90.2% of cases (IQR: 0 [0–1]), and foraminal stenosis improved in 68.3% (IQR: 1 [1–1]). Complications included residual leg pain (9.8%), deep vein thrombosis (4.9%), and no reoperations.Conclusions: PTED under local anesthesia is a safe and effective minimally invasive strategy for frail elderly patients with severe LSS, providing durable symptom relief and functional restoration. Lateral recess decompression is critical for optimal outcomes. Larger prospective studies are warranted to validate these findings.