Propensity score-matched analysis of percutaneous endoscopic versus conservative treatment for lumbar disc herniation in high-risk octogenarians

To compare the efficacy and safety of percutaneous endoscopic transforaminal discectomy (PETD) under local anesthesia with multidisciplinary team (MDT) support versus conservative treatment in ultra-elderly (≥ 85 years) high-risk patients with lumbar disc herniation (LDH). This retrospective study included 64 patients who underwent PETD and 64 propensity score-matched controls receiving conservative treatment. Propensity scores were generated using 1:1 nearest-neighbor matching without replacement (caliper = 0.02) based on age, gender, body mass index (BMI), number of comorbidities, herniated level, symptom duration, baseline Visual Analog Scale (VAS) scores, and Oswestry Disability Index (ODI), along with Clinical Frailty Scale (CFS) and Charlson Comorbidity Index (CCI). Outcomes included VAS for back/leg pain, ODI, modified Macnab criteria, crossover surgery rate, and complications. The mean follow-up duration was 14.2 ± 3.1 months in the PETD group and 13.8 ± 4.2 months in the conservative group. The PETD group showed significantly greater improvement in leg pain VAS and ODI at 3 months and 1 year (P < 0.01). The excellent/good rate was 95.31% vs. 31.25% (P < 0.001). In the conservative group, 28.13% crossed over to surgery. Under MDT management, 90.6% received medication optimization, with early ambulation (3.40 ± 0.88 h) and short hospital stay (2.34 ± 0.47 days). No serious complications occurred. Multivariate analysis confirmed that the treatment group was independently associated with an excellent or good Macnab outcome (OR = 25.6, 95%CI 8.4–78.1, P < 0.001) after adjusting for CFS and CCI. MDT-supported PETD under local anesthesia is safe and effective for ultra-elderly high-risk LDH patients, offering superior outcomes and rapid recovery compared to conservative treatment.