Minimally Invasive but not Minimally Painful: Endoscopic Spine Surgery Less Painful than Minimally Invasive Surgical Approaches

Introduction: Endoscopic and minimally invasive surgeries (MIS) have gained popularity for their ability to reduce postoperative complications, recovery time, and pain. This study investigates postoperative pain outcomes in patients undergoing minimally invasive and endoscopic spine surgeries.

Methods: We conducted a retrospective review of all endoscopic lumbar spine laminectomies performed at our tertiary care center from 2023-2024 (n=93). We then collected data on 100 MIS tubular laminectomies between 2021-2024 to serve as a comparison group. To characterize postoperative pain, we collected data on maximum postoperative pain within 6 months after surgery. Pain was classified based on a standard 0-10 scale. We excluded patients without data on postoperative pain and conducted statistics with SPSS.

Results: Seventy-three patients had data on maximum postoperative pain (26 MIS patients, 47 endoscopic patients). Maximum postoperative pain was significantly higher in patients who underwent MIS (H=12.83, p< 0.001). On average, patients undergoing MIS had a maximum postoperative pain of 7.58, while those who underwent endoscopic procedures reported maximum pain at 4.45 p< 0.001).

Conclusion : Following laminectomy or discectomy, patients undergoing MIS experience greater maximum postoperative pain compared to those undergoing endoscopic surgery. While both approaches minimize tissue damage, endoscopic procedures, with their smaller incisions and less muscle dissection, may contribute to reduced postoperative pain. Larger prospective studies are warranted to confirm the potential benefits of endoscopic surgery in reducing postoperative pain.