Outcomes Following Endoscopic Versus Open Single-Level Lumbar Discectomy

Introduction: Traditional open discectomy has been the standard treatment for lumbar disc herniation, but minimally invasive endoscopic approaches are increasingly being adopted. Comprehensive comparative analyses of these techniques regarding clinical outcomes remain limited. This study aimed to compare the short-term clinical outcomes of endoscopic versus open single-level lumbar discectomy, hypothesizing that the endoscopic approach reduces postoperative complications within one month of surgery.

Methods: This retrospective cohort study utilized the MARINER database, analyzing data from January 2017 to October 2022. Adult patients aged 18 to 74 years who underwent single-level lumbar discectomy were included. Initially, 243,684 patients were identified (1,470 endoscopic and 242,214 open surgeries). A 1:3 propensity score matching was applied based on age, sex, Charlson Comorbidity Index (CCI), and specific comorbidities, resulting in a well-balanced cohort of 5,640 patients (1,416 endoscopic; 4,224 open).

Results: The two groups' demographic and comorbidity profiles were closely aligned after matching. The endoscopic group demonstrated significantly lower rates of surgical site infections (0.35% vs. 0.95%; p < 0.05; OR 2.69, 95% CI 1.06–6.85), surgical complications (0.71% vs. 1.52%; p < 0.05; OR 2.16, 95% CI 1.11–4.17), and 30-day readmissions (2.47% vs. 7.65%; p < 0.05; OR 3.09, 95% CI 2.19–4.36). Kaplan-Meier survival analysis over 18 months showed no significant difference in the probability of subsequent lumbar fusion between groups (Log-Rank Test p = 0.8).

Conclusion : Endoscopic single-level lumbar discectomy is associated with fewer short-term complications than open surgery. These findings support considering endoscopic techniques as a lower-risk alternative for appropriate patients. Further studies assessing long-term outcomes are warranted.