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已发表论文
超老年患者腰椎间盘突出症经椎间孔硬膜外类固醇注射与经皮椎间孔镜椎间盘切除术的回顾性比较分析
Authors Zhou J, Hu A, Zhou X, Dong J
Received 29 September 2025
Accepted for publication 21 December 2025
Published 31 December 2025 Volume 2025:20 Pages 2749—2761
DOI https://doi.org/10.2147/CIA.S566242
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Zhi-Ying Wu
Jian Zhou,* An’nan Hu,* Xiaogang Zhou, Jian Dong
Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Jian Dong, Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People’s Republic of China, Tel +86-21-64041990, Fax +86-21-64432673, Email dong.jian@zs-hospital.sh.cn Xiaogang Zhou, Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People’s Republic of China, Tel +86-21-64041990, Fax +86-21-64432673, Email zhou.xiaogang@zs-hospital.sh.cn
Purpose: The rising global population aged over 80 has increased the incidence of degenerative spinal conditions causing lumbar radiculopathy. Minimally invasive treatments such as transforaminal epidural steroid injection (TESI) and percutaneous transforaminal endoscopic discectomy (PTED) are commonly used, yet their comparative effectiveness remains unclear. This study aimed to compare the clinical outcomes, safety, and efficacy of TESI and PTED in patients aged 80 and above.
Patients and Methods: : A retrospective analysis was conducted on 74 patients with conservative treatment-resistant lumbar radiculopathy. Patients were divided into TESI (n=40) and PTED (n=34) groups. Primary outcomes included Visual Analog Scale scores for back and leg pain (VAS-BP, VAS-LP), Oswestry Disability Index (ODI), and modified MacNab criteria. Secondary outcomes were operative time, fluoroscopy frequency, hospital stay, and complications. Assessments occurred preoperatively and at 1 week, 1, 3, 6, and 12 months post-procedure. Statistical analyses used ANOVA and chi-square tests.
Results: Both groups showed significant short-term improvement. At 6- and 12-month follow-ups, the PTED group demonstrated superior and sustained outcomes, with greater pain reduction (VAS-BP, VAS-LP), better functional improvement (ODI), and higher excellent/good MacNab rates (87.9% vs 64.9%, p< 0.05) compared to TESI. The TESI group had a higher recurrence rate (21.62% vs 6.06%). TESI was associated with shorter procedure times and hospital stays. No serious complications occurred in either group.
Conclusion: Both TESI and PTED are effective minimally invasive treatments for lumbar radiculopathy in very elderly patients. TESI offers quicker procedures and rapid symptom relief, while PTED provides more durable pain reduction and functional improvement. Treatment plans should be tailored to each individual, in accordance with established geriatric care principles that emphasize the consideration of comorbid conditions, specific pathology, and patient preferences. Further prospective randomized studies are needed to confirm these results.
Keywords: super elderly, lumbar radiculopathy, transforaminal epidural steroid injection, TESI, percutaneous transforaminal endoscopic discectomy, PTED, less invasive, treatment outcomes
Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Jian Dong, Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People’s Republic of China, Tel +86-21-64041990, Fax +86-21-64432673, Email dong.jian@zs-hospital.sh.cn Xiaogang Zhou, Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People’s Republic of China, Tel +86-21-64041990, Fax +86-21-64432673, Email zhou.xiaogang@zs-hospital.sh.cn
Purpose: The rising global population aged over 80 has increased the incidence of degenerative spinal conditions causing lumbar radiculopathy. Minimally invasive treatments such as transforaminal epidural steroid injection (TESI) and percutaneous transforaminal endoscopic discectomy (PTED) are commonly used, yet their comparative effectiveness remains unclear. This study aimed to compare the clinical outcomes, safety, and efficacy of TESI and PTED in patients aged 80 and above.
Patients and Methods: : A retrospective analysis was conducted on 74 patients with conservative treatment-resistant lumbar radiculopathy. Patients were divided into TESI (n=40) and PTED (n=34) groups. Primary outcomes included Visual Analog Scale scores for back and leg pain (VAS-BP, VAS-LP), Oswestry Disability Index (ODI), and modified MacNab criteria. Secondary outcomes were operative time, fluoroscopy frequency, hospital stay, and complications. Assessments occurred preoperatively and at 1 week, 1, 3, 6, and 12 months post-procedure. Statistical analyses used ANOVA and chi-square tests.
Results: Both groups showed significant short-term improvement. At 6- and 12-month follow-ups, the PTED group demonstrated superior and sustained outcomes, with greater pain reduction (VAS-BP, VAS-LP), better functional improvement (ODI), and higher excellent/good MacNab rates (87.9% vs 64.9%, p< 0.05) compared to TESI. The TESI group had a higher recurrence rate (21.62% vs 6.06%). TESI was associated with shorter procedure times and hospital stays. No serious complications occurred in either group.
Conclusion: Both TESI and PTED are effective minimally invasive treatments for lumbar radiculopathy in very elderly patients. TESI offers quicker procedures and rapid symptom relief, while PTED provides more durable pain reduction and functional improvement. Treatment plans should be tailored to each individual, in accordance with established geriatric care principles that emphasize the consideration of comorbid conditions, specific pathology, and patient preferences. Further prospective randomized studies are needed to confirm these results.
Keywords: super elderly, lumbar radiculopathy, transforaminal epidural steroid injection, TESI, percutaneous transforaminal endoscopic discectomy, PTED, less invasive, treatment outcomes