Spine - 2026-08-15 - Journal Article; Meta-Analysis; Systematic Review
Endoscopic Lumbar Surgery in the Elderly: An Age-Stratified Systematic Review and Meta-Analysis.
Elgeadi G, Caballero A, de Pedro M
Topics
Key Takeaway
Endoscopic spinal surgery in patients ≥80 years achieved VAS leg pain, VAS back pain, ODI, and Modified Macnab success rates statistically comparable to patients <80 years across 5,753 patients with no significant excess in complications.
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Summary
This systematic review and meta-analysis evaluated endoscopic spinal surgery (ESS) safety and effectiveness for degenerative lumbar disease stratified by age (<80 vs ≥80 years and <70 vs ≥70 years) across 19 studies. Pairwise random-effects meta-analysis showed no significant difference in VAS leg pain, VAS back pain, ODI improvement, or Modified Macnab success rates between the ≥80 and <80 cohorts, with comparable complication profiles. Single-arm pooling confirmed large, clinically meaningful pain and disability reductions in both the <70 and ≥70 strata.
Key Limitation
The predominance of retrospective cohort designs with implicit patient selection means complication rates and functional gains likely overestimate what would be observed in an unselected elderly population.
Original Abstract
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVE
To evaluate the safety and clinical effectiveness of endoscopic spinal surgery (ESS) for degenerative lumbar disease in very elderly patients, comparing outcomes in patients aged <80 versus ≥80 years, and summarizing age-stratified symptom and disability changes.
SUMMARY OF BACKGROUND DATA
Endoscopic spinal surgery (ESS) has gained adoption as a minimally invasive alternative to conventional lumbar decompression for degenerative lumbar pathology. However, its safety and effectiveness in very elderly patients remain uncertain, and age is often treated as a relative contraindication despite limited comparative evidence.
METHODS
We systematically searched PubMed, Scopus, Web of Science, and CENTRAL from inception to October 2025 for observational studies evaluating ESS for lumbar disc herniation, lumbar spinal stenosis, or degenerative lumbar pathology with age-stratified outcomes. Eligible studies reported Visual Analog Scale (VAS) leg and/or back pain, Oswestry Disability Index (ODI), Modified Macnab criteria, or complications. Comparative random-effects meta-analyses were performed for patients aged <80 versus ≥80 years. Single-arm meta-analyses summarized mean changes in pain and disability across the <70 and ≥70-year strata.
RESULTS
Nineteen studies (14 retrospective cohorts, 3 prospective cohorts, 2 case series; 5753 patients) published between 2014 and 2025 were included. ESS was predominantly performed for lumbar spinal stenosis (11 studies) and disc herniation (7 studies), with follow-up ranging from 3 to 120 months. In pairwise analyses, patients ≥80 years achieved improvements in VAS leg pain, VAS back pain, ODI, and Modified Macnab success that were comparable to those <80 years, with no significant excess in complications. Single-arm pooling demonstrated large, clinically meaningful reductions in pain and disability in both the <70- and ≥70-year groups, without significant between-group differences.
CONCLUSIONS
Endoscopic spinal surgery (ESS) provides substantial and comparable symptom relief and functional improvement across age strata, supporting its use in carefully selected elderly and very elderly patients. Chronological age alone should not contraindicate ESS; future prospective, age-focused comparative studies are warranted.