Developing consensus for the utilization of endoscopy in lumbar decompression: a phase 1 systematic review-informed modified Delphi study

Introduction: Minimally invasive surgical (MIS) approaches have become increasingly popular for the treatment of spine pathologies. In particular, spinal endoscopy has shown great promise in this arena. To reach consensus regarding use of endoscopy in lumbar decompression surgery, we employ a systematic review-informed approach (Phase 1) to a modified Delphi study (Phase 2). Here, we present the data from phase 1 of the current study.

Methods: An a priori PRISMA review from PudMed, Embase, Scopus and hand searches were queried. Inclusion consisted of 1) lumbar spinal surgery, 2) level 1 a/b and 2a study evidence. Patient data postoperative pain scoring outcomes were evaluated using multivariate mixed-effects regression modeling.

Results: Of 6891 articles, 5469 unique articles were included for title abstract screening, of which 164 full-text articles describing endoscopic lumbar decompression were evaluated. For the final synthesis, 57 studies conducted between 2019-2024 were included from Asia (64.9%), North America (17.5%) and Europe (10.5) comprising a total of 1281 participants. Participants had an average age of 63.0 +/- 2.6, BMI of 26.2 +/- 2.3, and consisted of more females (52.2%). Preoperatively, weakness (26.3%), focal pain (26.3%), and radicular pain (21.1%) were the most common presenting symptoms. Operative levels most frequently included L5-S1 (37.0%) and L4-5 (34.2%). Complications were rare (2.3%), with most involving dural tears (68.4%) and infections (31.6%). Postoperatively, a VAS score for generalized pain was 2.3 (95% CI: 1.42 to 4.21) and improved to 1.37 (95% CI: 0.74 to 1.99) after 1-month postop.

Conclusion : This review suggests that older females with an overweight BMI, focal symptoms and weakness, and lower lumbar pathology are most often selected for endoscopic lumbar decompression. Improved VAS outcomes after one month were significantly observed. A phase 2 implementation of this study will help reach a consensus regarding the patients best suited for endoscopic lumbar decompression.