Abstract
BACKGROUND: Endoscopic spine surgery (ESS) has evolved as a new minimally invasive surgical (MIS) approach to the lumbar spine. ESS allows smaller incisions, less paraspinal muscle splitting and surgical trauma compared to conventional open and MIS approaches. We present the first non-inferiority comparison of ESS and open approaches to treat lumbar radiculopathy in an Australian cohort. The aim of this study is to assess if ESS is non-inferior to open approaches for the treatment of lumbar radiculopathy in post operative outcomes of pain and disability scores, in order to address the paucity in data for outcomes of ESS in Australian patients. METHODS: In this retrospective cohort study, routinely collected prospective data were collated from consecutive patients who had single level endoscopic discectomies for radiculopathy by two surgeons at a single institution between December 2020 and October 2022. Data collected included Visual Analogue Scores for Back (VAS-B) and leg (VAS-L) pain as well as Oswestry Disability Index (ODI) scores, length of stay (LOS) and complication rates. These were compared to data from consecutive patients who underwent open discectomies from August 2020 to September 2022 by the same surgeons at other private hospitals where the endoscope was unavailable, otherwise deemed suitable for either approach, allowing direct comparison of consecutive patients operated on for comparable pathologies differentiated only by equipment availability. RESULTS: Analysis included 92 endoscopic and 97 open cases. Non-inferiority was established at 6-week with median VAS-L (1.0 vs. 1.8, between group difference -0.5, P<0.001), VAS-B (1.0 vs. 1.0, between group difference -0.3, P=0.002) and ODI (18 vs. 20, between group difference -0.5, P<0.001) and 6-month for ODI (14 vs. 20, between group difference -1.6, P<0.001). Six-month median VAS-L and VAS-B was identical between groups (1.0 and 2.0), however this was not statistically significant. LOS was lower in ESS (LOS <24 h 93% vs. 78%, P=0.005). Reoperation rates were similar (10% vs. 7%, P=0.73). There were fewer complications in the endoscopic cohort than in the open cohort (5% vs. 6%), however this was not statistically significant. CONCLUSIONS: ESS is non-inferior to open decompression for the management of lumbar radiculopathy up to 6 months. LOS was also found to be lower in ESS. There were fewer complications with ESS however this was not statistically significant.