Full-Endoscopic Spinal Surgery for Older Patients With Degenerative Spinal Pathology: A Narrative Review

The aging population worldwide is experiencing an increasing incidence of degenerative spinal disorders, leading to significant morbidity and diminished quality of life. Traditional open surgical approaches for treating these conditions in older patients often entail substantial risks and prolonged recovery times. However, recent advancements in endoscopic surgical techniques have provided promising alternatives with potentially reduced morbidity and quicker recovery. This paper reviews the current literature regarding full-endoscopic spinal surgery (FESS) for degenerative spinal pathology in older patients. We discuss the evolution of endoscopic techniques, patient selection criteria, surgical indications, outcomes, and complications associated with FESS in older adults. Several studies have reported favorable outcomes of FESS in older patients, including reduced postoperative pain, shorter hospital stays, faster recovery, and comparable or even improved clinical outcomes compared with traditional open surgery. Moreover, FESS offers the advantages of minimal tissue disruption, preservation of spinal stability, and decreased blood loss, which are particularly advantageous in older patients with multiple comorbidities. However, challenges such as a steep learning curve for surgeons, limited visualization, and technical constraints in managing complex pathologies remain significant concerns. Additionally, the long-term durability and effectiveness of FESS in older patients require further investigation. In conclusion, FESS presents a promising minimally invasive option for treating degenerative spinal pathology in older adults. Further research and technological advancements are needed to optimize patient selection, refine surgical techniques, and improve long-term outcomes in this growing demographic category of patients.