Research on the Application of Enhanced Recovery After Surgery (ERAS) Concept Combined with Wiltse Approach TLIF in Elderly Patients with Lumbar Spinal Stenosis

Abstract

Objective: To evaluate the clinical efficacy and safety of the enhanced recovery after surgery (ERAS) concept combined with the Wiltse intermuscular approach transforaminal lumbar interbody fusion (TLIF) in the treatment of elderly patients with lumbar spinal stenosis. Methods: A prospective study was conducted on 63 elderly patients with lumbar degenerative diseases and lumbar spinal stenosis admitted to our hospital from February 2021 to June 2022, aged ≥60 years. Patients were randomly divided into an ERAS group (32 cases) and a control group (31 cases) using a random number table method. The ERAS group received standardized perioperative management based on the ERAS concept and underwent TLIF via the Wiltse intermuscular approach, while the control group received conventional perioperative management and underwent TLIF via the traditional posterior median approach. Perioperative indicators such as general patient information, length of hospital stay, operative time, intraoperative blood loss, and postoperative complications were compared between the two groups. Pain in the affected limb was assessed using the visual analogue scale (VAS) before surgery and on postoperative days 1, 3, and at 1 month and 3 months. Functional status was evaluated using the Oswestry disability index (ODI) before surgery and at 1, 3, and 6 months postoperatively. The overall therapeutic effect was evaluated according to the modified MacNab criteria at the last follow-up. Results: There were no statistically significant differences in general patient information between the two groups (P > 0.05). Compared with the control group, the ERAS group had significantly reduced intraoperative blood loss and postoperative hospital stay (P < 0.05). There were no statistically significant differences in operative time, preoperative VAS score for pain in the affected limb, or preoperative ODI score between the two groups (P > 0.05). The VAS scores in the ERAS group were significantly lower than those in the control group on postoperative days 1, 3, and at 1 month and 3 months (P < 0.05), with no significant difference between the two groups at 3 months postoperatively (P > 0.05). The ODI scores in the ERAS group were significantly better than those in the control group at 1, 3, and 6 months postoperatively (P < 0.05). At the last follow-up, according to the modified MacNab criteria, the ERAS group had 29 excellent cases, 2 good cases, and 1 fair case, with an excellent and good rate of 96.9%; the control group had 26 excellent cases, 2 good cases, and 3 fair cases, with an excellent and good rate of 90.3%. There were 4 postoperative complications in the ERAS group and 9 in the control group, with no postoperative readmissions or deaths within 30 days postoperatively in either group. Conclusion: The application of the ERAS concept combined with the Wiltse approach TLIF in elderly patients with lumbar spinal stenosis can reduce blood loss and complications, alleviate early postoperative pain, accelerate functional recovery, and shorten hospital stay while ensuring surgical safety, which is of great clinical significance.