Analysis of the therapeutic effect and postoperative complications associated with 3-dimensional computed tomography navigation-assisted intervertebral foraminoscopic surgery in lumbar disc herniation in the elderly: a retrospective cohort study.

BACKGROUND: With the increasing aging of the population, the incidence of lumbar disc herniation (LDH) is gradually increasing. The 3-dimensional (3D) computed tomography (CT) navigation-assisted intervertebral foraminoscopic surgery for LDH is minimally invasive, and due to its localization and guidance features, it can precisely reach the target location. This study sought to investigate the treatment effect and the incidence of postoperative complications of 3D CT navigation-assisted intervertebral foraminoscopic surgery in elderly patients with LDH to provide a reference basis for improving patient prognosis.

METHODS: We retrospectively included 213 elderly patients with LDH admitted to our hospital from October 2017 to October 2021 in this study and followed them up for 1 year. Among them, 103 patients (Group A) underwent conventional C-arm fluoroscopy-assisted system alone intervertebral foraminoscopic surgery, and 110 patients (Group B) underwent 3D CT navigation-assisted intervertebral foraminoscopic surgery. The general characteristics of the participants were compiled using a general information questionnaire designed by the investigator. The t -test and chi-square test were used to analyze the relationship between the treatment outcomes and surgical modalities. Binary logistics regression was used to analyze the independent risk factors affecting patient outcomes.

RESULTS: The patients who underwent 3D CT navigation-assisted intervertebral foraminoscopic surgery had significantly better outcomes than those who underwent conventional C-arm fluoroscopy-assisted system alone intervertebral foraminoscopic surgery. The binary logistic regression analysis results showed that in addition to the surgical method [odds ratio (OR) =0.258, P=0.042], the history of lumbar trauma (OR =11.001, P=0.005), usual work intensity (OR =4.589, P=0.002), disease duration (OR =3.587, P=0.017), the presence of diabetes (OR =3.315, P=0.026), the presence of a ruptured annulus fibrosus (OR =3.485, P=0.012), the degree of disc degeneration (OR =3.899, P=0.009), and the number of punctures (OR =0.412, P=0.034) were independent risk factors affecting patient outcomes.

CONCLUSIONS: 3D CT navigation-assisted intervertebral foraminoscopic surgery for LDH effectively reduced the number of punctures, decreased intraoperative bleeding and postoperative drainage volumes, shortened the length of hospitalization, bed rest time and operative time, reduced stress reactions, decreased the degree of low-back pain, and the risk of complications, had better overall efficacy, and significantly improved patient prognosis.