World neurosurgery · 2026
Short-Term Outcomes and 2-Year Reoperations Following Endoscopic versus Microdiscectomy for Lumbar Disc Herniation: A Propensity-Matched Analysis.
СтатьяСравнительное исследованиеМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Wang Ryan, Zeng William, Hong Alexander T, Cho Hannah, Khalid Syed I, Mehta Ankit I
Аннотация
BACKGROUND: Endoscopic lumbar discectomy has gained popularity as a minimally invasive alternative to microdiscectomy, yet large-scale comparative data evaluating postoperative durability remain limited. This study assessed short-term complications and 2-year reoperation rates between endoscopic and microdiscectomy cohorts using a large multicenter database.
METHODS: A retrospective cohort analysis was performed using the TriNetX US Collaborative Network. Adult patients undergoing endoscopic discectomy or microdiscectomy for lumbar disc herniation were identified using Current Procedural Terminology codes. A 1:1 propensity score matching was performed for demographics and baseline comorbidities. Ninety-day medical and surgical complications, hospital readmission, and emergency department utilization were evaluated using risk ratios (RRs). Two-year repeat lumbar decompression, subsequent lumbar fusion, and postlaminectomy syndrome were analyzed using Cox proportional hazards models.
RESULTS: At 90 days, composite medical complications were significantly lower following endoscopic discectomy compared with microdiscectomy (2.3% vs. 3.7%; RR 0.61, 95% confidence interval (CI) 0.41-0.93; P=0.020), as were composite surgical complications (0.9% vs. 2.5%; RR 0.37, 95% CI 0.20-0.68; P=0.001). Hospital readmission and emergency department visits were not significantly different (P>0.05). At two years, endoscopic discectomy was associated with a higher risk of repeat lumbar decompression (8.3% vs. 4.3%; hazard ratio 2.03, 95% CI 1.45-2.83; P<0.001) and postlaminectomy syndrome (4.5% vs. 3.1%; hazard ratio 1.58, 95% CI 1.08-2.30; P=0.018). Subsequent lumbar fusion rates were low and comparable between groups (3.5% vs. 3.3%; P=0.595).
CONCLUSION: Endoscopic lumbar discectomy offers improved perioperative safety but reduced 2-year durability compared with microdiscectomy, highlighting the need to balance short-term advantages with long-term reoperation risk.
METHODS: A retrospective cohort analysis was performed using the TriNetX US Collaborative Network. Adult patients undergoing endoscopic discectomy or microdiscectomy for lumbar disc herniation were identified using Current Procedural Terminology codes. A 1:1 propensity score matching was performed for demographics and baseline comorbidities. Ninety-day medical and surgical complications, hospital readmission, and emergency department utilization were evaluated using risk ratios (RRs). Two-year repeat lumbar decompression, subsequent lumbar fusion, and postlaminectomy syndrome were analyzed using Cox proportional hazards models.
RESULTS: At 90 days, composite medical complications were significantly lower following endoscopic discectomy compared with microdiscectomy (2.3% vs. 3.7%; RR 0.61, 95% confidence interval (CI) 0.41-0.93; P=0.020), as were composite surgical complications (0.9% vs. 2.5%; RR 0.37, 95% CI 0.20-0.68; P=0.001). Hospital readmission and emergency department visits were not significantly different (P>0.05). At two years, endoscopic discectomy was associated with a higher risk of repeat lumbar decompression (8.3% vs. 4.3%; hazard ratio 2.03, 95% CI 1.45-2.83; P<0.001) and postlaminectomy syndrome (4.5% vs. 3.1%; hazard ratio 1.58, 95% CI 1.08-2.30; P=0.018). Subsequent lumbar fusion rates were low and comparable between groups (3.5% vs. 3.3%; P=0.595).
CONCLUSION: Endoscopic lumbar discectomy offers improved perioperative safety but reduced 2-year durability compared with microdiscectomy, highlighting the need to balance short-term advantages with long-term reoperation risk.