Spine - 2026-05-15 - Journal Article; Comparative Study
Open Versus Endoscopic Lumbar Discectomy : A Propensity-Matched Analysis of 2618 Surgical Patients.
Perez-Albela A, Singh M, Kim J, Jensen M, Snigur G, Daniels AH, Basques BA
Topics
Key Takeaway
Endoscopic discectomy reduced dural tear rate from 1.15% to 0.15% (OR 0.179) and SSI from 1.15% to 0.08% (OR 0.082) compared to open discectomy in a propensity-matched cohort of 2,618 patients.
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Summary
This study used the PearlDiver database (2010–2022) with 1:1 propensity score matching on age, sex, and CCI to compare endoscopic versus open lumbar discectomy outcomes. ED was associated with significantly lower rates of dural tears (0.15% vs. 1.15%, OR 0.179), SSI (0.08% vs. 1.15%, OR 0.082), wound complications (0.38% vs. 1.07%, OR 0.342), and persistent pain (2.22% vs. 2.83%, OR 0.665). Two-year reoperation rates and rates of DVT, UTI, and nerve injury were not significantly different between groups.
Key Limitation
Administrative database coding cannot capture surgeon endoscopic experience or learning curve effects, which likely confound the complication rates attributed to the technique itself.
Original Abstract
STUDY DESIGN
Retrospective cohort study.
OBJECTIVE
To compare intraoperative complications, 90-day medical complications, and 2-year surgical reoperation rates between endoscopic discectomy (ED) and open discectomy (OD).
BACKGROUND
Symptomatic lumbar disc herniation is common, with discectomy serving as a common surgical intervention. Previous studies comparing ED and OD show inconsistent findings regarding complications and long-term outcomes, often limited by small sample sizes and study heterogeneity.
MATERIALS AND METHODS
Patients undergoing ED (CPT-62380) and OD (CPT-63030) from 2010 to 2022 were identified using PearlDiver database. Propensity score matching (1:1) controlled for age, sex, and Charlson Comorbidity Index (CCI). Outcomes included intraoperative complications such as dural tears and nerve injuries, 90-day medical complications including deep vein thrombosis (DVT), surgical site infections (SSI), dura repair, and urinary tract infections (UTI), and 2-year reoperations. Statistical analyses utilized χ 2 tests, t tests, and multivariate logistic regression adjusting for comorbidities. Odds ratios (OR) with 95% CIs were reported.
RESULTS
A total of 2618 patients were identified and examined (1309 ED, 1309 OD). On multivariate analysis, ED was associated with a significantly lower risk of dural tears (0.15% vs . 1.15%, OR: 0.179, P = 0.006), surgical site infections (0.08% vs . 1.15%, OR: 0.082, P = 0.001), wound complications (0.38% vs . 1.07%, OR: 0.342, P = 0.023), and dura repair (0.08% vs . 0.69%, OR: 0.091, P = 0.021). ED was also associated with lower odds of persistent pain (2.22% vs . 2.83%, OR: 0.665, P = 0.048). No significant differences were observed in nerve injuries, DVT, UTI, or readmissions.
CONCLUSION
ED is associated with fewer dural tears, surgical site infections, wound complications, and dura repairs, along with lower odds of persistent pain compared with OD. Rates of DVT, UTI, and reoperations were not significantly different between groups.