Abstract
Neurogenic claudication due to a herniated disc, spinal stenosis, instability,
or deformity is typical in the elderly. When conservative management fails, and the
patient’s disability prevents a healthy lifestyle, surgery is often recommended. There
are multiple concerns with open spine surgery in the geriatric patient population,
including medical comorbidities and fewer overall reserves to tolerate aggressive
operations with high blood loss and long operating times. Endoscopic foraminal
decompression has gained popularity and is now openly competing with open
decompression and fusion operations by focusing the treatment on validated pain
generators. Such simplified treatments often consist of targeted single-level and
unilateral neuroforaminal decompressions. It is evident that appropriate patient
selection and a diagnostic workup employing validated prognosticators of a favorable
outcome are necessary to make such an endoscopic spinal surgery program work in the
elderly. In this chapter, the authors describe their patient selection algorithms and
preferred surgical techniques. In their experience, high patient satisfaction may be
achieved when employing their clinical protocols.
Keywords: Geriatric patients, Neurogenic claudication, Spinal stenosis