The number of older patients experiencing difficulty with daily activities due to lower back pain and leg numbness is increasing. However, many patients delay receiving appropriate treatment because of the belief that “spine surgery is dangerous” or “surgery is not possible due to old age.”
According to medical sources on July 20, spine surgery has continued to advance over the past decade. Recently, the development of unilateral biportal endoscopic (UBE) spine surgery, which minimizes incision size and accelerates recovery, has expanded treatment options for older patients.
Spinal stenosis and herniated discs are among the most common spinal disorders in people aged 65 and older. Spinal stenosis occurs when aging causes the bones and ligaments surrounding the spine to thicken, narrowing the passageway through which nerves travel.
A typical symptom is neurogenic claudication, which causes severe leg numbness and pain that can feel as if the legs are about to give out even after walking a short distance. Neurogenic claudication refers to a condition in which leg pain or numbness worsens while walking, requiring rest, and symptoms improve when sitting down or bending forward. A herniated disc occurs when a spinal disc protrudes and compresses nerves, causing lower back pain as well as radiating pain that extends to the hips and legs.
In the early stages of the disease, symptoms may improve through non-surgical treatments such as medication, physical therapy and injections. However, surgery may be considered when symptoms persist or nerve compression becomes severe. For older patients, however, the burden of general anesthesia and larger incisions can be significant because many have underlying conditions such as high blood pressure, diabetes and heart disease.
Unilateral biportal endoscopic spine surgery is a minimally invasive procedure that creates two small incision openings of about 1 centimeter in the lower back. A high-definition endoscopic camera is inserted through one opening, while surgical instruments are inserted through the other to remove the affected area.
Because the endoscope and surgical instruments use separate channels, the procedure provides better visibility and greater flexibility in instrument control, allowing surgeons to more precisely remove discs or thickened ligaments compressing nerves.
The procedure can also be performed under local or spinal anesthesia depending on the patient’s condition, reducing the burden associated with anesthesia. Because it minimizes damage to muscles and normal tissues, the surgery results in less bleeding and postoperative pain. Most patients are able to walk the day after surgery and are discharged within an average of three to five days.
The ability to quickly return to daily life can help prevent complications in older patients caused by prolonged hospitalization, including pneumonia, pressure sores and muscle weakness.
However, unilateral biportal endoscopic spine surgery is not suitable for every patient with spinal disorders. Patients with severe spinal instability or deformities may require other procedures, such as spinal fusion surgery. Since the appropriate surgical method varies depending on factors including bone density and underlying health conditions, consultation with a specialist is essential.
“Many patients in the past hesitated to undergo spine surgery simply because they were elderly,” said Oh Young-gyu, professor of neurosurgery at Korea University Anam Hospital. “With advances in minimally invasive surgery, older patients now have options to undergo surgery relatively safely. With an accurate diagnosis and appropriate treatment, patients can still walk hand in hand with their grandchildren even in their 80s.”