Purpose: Although percutaneous endoscopic lumbar decompression (PELD) has achieved substantial technical advancements over recent decades, it still presents considerable technical challenges in elderly patients with high iliac crest morphology who have concomitant lumbar foraminal stenosis and nerve root canal stenosis. To evaluate the preliminary clinical efficacy of percutaneous endoscopic lumbar decompression (PELD) assisted by an L-shaped impactor system in elderly patients with high iliac crest anatomy complicated by lumbar foraminal stenosis.
Methods: A retrospective cohort analysis was conducted on 40 elderly patients with high iliac crest anatomy and radiologically confirmed foraminal stenosis who underwent L-shaped impactor-assisted PELD between January 2022 and August 2023. Patients were divided into early (first 20 cases) and late (latter 20 cases) groups by surgical order. Outcome measures included preoperative/postoperative visual analog scale (VAS) scores for low back/leg pain, Oswestry Disability Index (ODI), MacNab criteria (1 day, 3-month, and 12-month follow-ups), and foraminal anteroposterior diameter, operation time, blood loss, and complications.
Results: VAS scores significantly improved from 6.83 ± 1.03 preoperatively to 3.00 ± 0.72 at 12 months. ODI scores decreased progressively from 55.9 ± 4.9 to 11.7 ± 1.9 at final follow-up. Excellent/good outcomes by MacNab criteria were achieved in 92.5% of patients at 12 months. Complications included transient dysesthesia (one case) and aggravated postoperative low back pain (one case). Compared with the early group, the late group had shorter operation time (58.90 ± 6.91 vs. 66.05 ± 7.26 min), less blood loss (30.85 ± 5.84 vs. 36.10 ± 6.75 mL), and lower postoperative VAS (3.80 ± 1.17 vs. 4.65 ± 1.23 < 0.05).
Conclusion: The L-shaped impactor-assisted PELD technique demonstrates favorable clinical efficacy in treating foraminal stenosis in elderly patients with high iliac crest anatomy. A favorable learning curve exists: more experience shortens operative time, reduces blood loss, and improves postoperative pain control without compromising safety. This minimally invasive approach may serve as a feasible surgical option for anatomically complex cases, warranting further prospective validation.
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2026 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.
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