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.