Comparative Outcomes of Endoscopic vs. Open Lumbar Decompression for Lumbar spinal stenosis: A Multi-Year, Multicenter Analysis

Introduction: Lumbar spinal stenosis is a leading reason for back surgery in older adults. While open laminectomy is the standard decompression technique, it often causes significant soft tissue damage. Micro endoscopic decompression offers a minimally invasive alternative, but evidence comparing these methods is limited.

Methods: This retrospective cohort study used ACS-NSQIP data (2017–2020) to compare outcomes of endoscopic and open lumbar decompression. We analyzed patient demographics, comorbidities, and outcomes like operative time, length of stay, complications, and readmissions, hypothesizing that endoscopic decompression might reduce complications and improve efficiency. Chi-square and t-tests assessed differences between the groups.

Results: A total of 43,704 patients were identified, with 196 (0.45%) undergoing endoscopic decompression and 43,508 (99.55%) undergoing open decompression. There was no significant difference in the mean age, height, weight, or BMI between the groups. The length of hospital stay was slightly shorter in the endoscopic group (mean 0.98 days) compared to the open group (mean 1.35 days), but this difference was not statistically significant (p = 0.2554). Similarly, there was no significant difference in operative time (99.22 minutes for endoscopic vs. 101.65 minutes for open, p = 0.6122). Complication rates, including reoperation, readmission, infection, and pulmonary, cardiac, and renal issues, showed no statistically significant differences between groups (p > 0.05 in all cases). Logistic regression analysis showed significant temporal trends in the use of endoscopic decompression compared to open surgery. Compared to 2017, the odds of endoscopic decompression increased significantly with adjusted predictions showing an increase from 0.0031 in 2017 to 0.0070 in 2020, with a significant trend P value ( < 0.001).

Conclusion : Endoscopic decompression for lumbar stenosis did not demonstrate a statistically significant reduction in adverse events, length of stay, or operative time compared to open decompression in this large, multicenter sample. However, there is an increasing trend in the use of endoscopic decompression over time, which may reflect growing provider and patient interest in minimally invasive options.