{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T02:44:24Z","timestamp":1775616264659,"version":"3.50.1"},"reference-count":19,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T00:00:00Z","timestamp":1773964800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T00:00:00Z","timestamp":1773964800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100013059","name":"Jiangsu Provincial Medical Youth Talent","doi-asserted-by":"publisher","award":["QNRC2016392"],"award-info":[{"award-number":["QNRC2016392"]}],"id":[{"id":"10.13039\/501100013059","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Although percutaneous endoscopic lumbar decompression (PELD) has achieved substantial technical advancements over recent decades, it still presents considerable technical challenges in elderly patients with high iliac crest morphology who have concomitant lumbar foraminal stenosis and nerve root canal stenosis. To evaluate the preliminary clinical efficacy of percutaneous endoscopic lumbar decompression (PELD) assisted by an L\u2010shaped impactor system in elderly patients with high iliac crest anatomy complicated by lumbar foraminal stenosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort analysis was conducted on 40 elderly patients with high iliac crest anatomy and radiologically confirmed foraminal stenosis who underwent L\u2010shaped impactor\u2010assisted PELD between January 2022 and August 2023. Patients were divided into early (first 20 cases) and late (latter 20 cases) groups by surgical order. Outcome measures included preoperative\/postoperative visual analog scale (VAS) scores for low back\/leg pain, Oswestry Disability Index (ODI), MacNab criteria (1\u2009day, 3\u2010month, and 12\u2010month follow\u2010ups), and foraminal anteroposterior diameter, operation time, blood loss, and complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>VAS scores significantly improved from 6.83\u2009\u00b1\u20091.03 preoperatively to 3.00\u2009\u00b1\u20090.72 at 12\u2009months. ODI scores decreased progressively from 55.9\u2009\u00b1\u20094.9 to 11.7\u2009\u00b1\u20091.9 at final follow\u2010up. Excellent\/good outcomes by MacNab criteria were achieved in 92.5% of patients at 12\u2009months. Complications included transient dysesthesia (one case) and aggravated postoperative low back pain (one case). Compared with the early group, the late group had shorter operation time (58.90\u2009\u00b1\u20096.91 vs. 66.05\u2009\u00b1\u20097.26\u2009min), less blood loss (30.85\u2009\u00b1\u20095.84 vs. 36.10\u2009\u00b1\u20096.75\u2009mL), and lower postoperative VAS (3.80\u2009\u00b1\u20091.17 vs. 4.65\u2009\u00b1\u20091.23\u2009&lt;\u20090.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The L\u2010shaped impactor\u2010assisted PELD technique demonstrates favorable clinical efficacy in treating foraminal stenosis in elderly patients with high iliac crest anatomy. A favorable learning curve exists: more experience shortens operative time, reduces blood loss, and improves postoperative pain control without compromising safety. This minimally invasive approach may serve as a feasible surgical option for anatomically complex cases, warranting further prospective validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/os.70286","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T07:33:28Z","timestamp":1773992008000},"page":"885-892","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Percutaneous Endoscopic Lumbar Decompression Using a Novel L\u2010Shaped Impactor for Treating Lumbar Foraminal and Nerve Root Canal Stenosis in Elderly Patients With High Iliac Crests: A Retrospective Cohort Study"],"prefix":"10.1111","volume":"18","author":[{"given":"Mengzi","family":"Hu","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery Xuzhou Clinical School of Xuzhou Medical University  Xuzhou Jiangsu China"},{"name":"Department of Orthopedic Surgery Xuzhou Central Hospital  Xuzhou Jiangsu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhenfei","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Xuzhou Central Hospital  Xuzhou Jiangsu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Quan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Xuzhou Clinical School of Xuzhou Medical University  Xuzhou Jiangsu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chunzeng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Xuzhou Central Hospital  Xuzhou Jiangsu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianwei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Xuzhou Central Hospital  Xuzhou Jiangsu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guangwang","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Xuzhou Clinical School of Xuzhou Medical University  Xuzhou Jiangsu China"},{"name":"Department of Orthopedic Surgery Xuzhou Central Hospital  Xuzhou Jiangsu China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,3,20]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.5921"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-024-03653-z"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00064-005-1156-9"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14061925"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-025-92128-z"},{"issue":"8","key":"e_1_2_13_7_1","first-page":"1392","article-title":"Risk of Reoperation and Infection After Percutaneous Endoscopic Lumbar Discectomy and Open Lumbar Discectomy: A Nationwide Population\u2010Based Study","volume":"103","author":"Kang T. W.","year":"2021","journal-title":"Bone & Joint Journal"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14165726"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14113685"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14082725"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13020515"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2024.1409088"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2022.890371"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.3171\/2021.8.SPINE21890"},{"key":"e_1_2_13_15_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2018\/2601232","article-title":"Transforaminal Percutaneous Endoscopic Lumbar Decompression by Using Rigid Bendable Burr for Lumbar Lateral Recess Stenosis: Technique and Clinical Outcome","volume":"2018","author":"Tang S.","year":"2018","journal-title":"BioMed Research International"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2017.06.012"},{"issue":"3","key":"e_1_2_13_17_1","first-page":"305","article-title":"Can the Novel LumboIliac Triangle Technique Based on Biplane Oblique Fluoroscopy Facilitate Transforaminal Percutaneous Endoscopic Lumbar Discectomy for Patients With L5\u2010S1 Disc Herniation Combined With High Iliac Crest? Case\u2010Control Study of 100 Patients","volume":"23","author":"Yang J. S.","year":"2020","journal-title":"Pain Physician"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.3892\/etm.2021.10298"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/os.13355"},{"issue":"8","key":"e_1_2_13_20_1","first-page":"E1191","article-title":"Transforaminal Versus Interlaminar Approach of Full\u2010Endoscopic Lumbar Discectomy Under Local Anesthesia for L5\/S1 Disc Herniation: A Randomized Controlled Trial","volume":"25","author":"Chen Z.","year":"2022","journal-title":"Pain Physician"}],"container-title":["Orthopaedic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/os.70286","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/os.70286","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/os.70286","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T01:52:03Z","timestamp":1775613123000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/os.70286"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,20]]},"references-count":19,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1111\/os.70286"],"URL":"https:\/\/doi.org\/10.1111\/os.70286","archive":["Portico"],"relation":{},"ISSN":["1757-7853","1757-7861"],"issn-type":[{"value":"1757-7853","type":"print"},{"value":"1757-7861","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,20]]},"assertion":[{"value":"2025-08-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}