Comparative Effects and Safety of Full-Endoscopic Versus Microscopic Spinal Decompression for Lumbar Spinal Stenosis: A Meta-Analysis and Statistical Power Analysis of 6 Randomized Controlled Trials

Abstract

Objective: This meta-analysis with statistical power analysis aimed to evaluate the difference between full-endoscopic and microscopic spinal decompression in treating spinal stenosis.Methods: We searched PubMed, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and CNKI (China National Knowledge Infrastructure) for relevant randomized controlled trials (RCTs) regarding the comparison of full-endoscopic versus microscopic spinal decompression in treating lumbar spinal stenosis through February 28, 2022. Two independent investigators selected studies, extracted information, and appraised methodological quality. Meta-analysis was conducted using RevMan 5.4 and STATA 14.0, and statistical power analysis was performed using G*Power 3.1.Results: Six RCTs involving 646 patients met selection criteria. Meta-analysis suggested that, compared with microscopic decompression, full-endoscopic spinal decompression achieved more leg pain improvement (mean difference [MD], -0.20; 95% confidence interval [CI], -0.30 to -0.10; p = 0.001), shortened operative time (MD, -12.71; 95% CI, -18.27 to -7.15; p < 0.001), and decreased the incidence of complications (risk ratio, 0.43; 95% CI, 0.22–0.82; p = 0.01), which was supported by a statistical power of 98.57%, 99.97%, and 81.88%, respectively.Conclusion: Full-endoscopic spinal decompression is a better treatment for lumbar spinal stenosis, showing more effective leg pain improvement, shorter operative time, and fewer complications than microscopic decompression.

The Role and Clinical Outcomes of Endoscopic Spine Surgery of Treating Spinal Metastases; Outcomes of 29 Cases From 8 Countries

“…Using the recent AOSpine Nomenclature in endoscopic spine surgery [ 23 ], we summarized these advancements and their expanding indications in Table 5 . With the larger working cannula and specialized armamentarium [ 9 ], it has been able to expand the surgical indications from simple decompression reaching up to lumbar interbody fusion [ 24 , 25 ], and more complicated spine surgery (e.g., infection) [ 26 ], with noninferiority to better results compared to the traditional MISS procedures [ 10 - 12 , 27 ]. However, because the support of these technical evolutions is very recent, report of its use in spinal metastases is still scarce.…”

Learning curve of percutaneous transforaminal endoscopic discectomy with visualized foraminoplasty for lumbar spinal stenosis

“…Author ' information 1 Spinal Orthopedics, Yueyang Hospital of Traditional Chinese Medicine, 414000,Yueyang, China, 2 Orthopaedic Surgery, Gulin People's Hospital, 646000, Luzhou, China, 3 Joint Orthopedics, Yueyang Hospital of Traditional Chinese Medicine, 414000,Yueyang, China 4 Neurospinal Surgery, Luzhou People's Hospital, 646000, Luzhou, China.…”

Interlaminar Endoscopic Lumbar Discectomy Versus Microscopic Lumbar Discectomy: A Preliminary Analysis of L5–S1 Lumbar Disc Herniation Outcomes in Prospective Randomized Controlled Trials

“…[11][12][13] Recently, advancements in techniques and iterative improvements in instrumentation have facilitated the global adoption of MIS techniques, whether in microscopic or endoscopic surgery. 14,15 Innovations, such as enhanced display pixel resolution or the enhanced intraoperative navigation guidance system, have significantly increased the efficiency and effectiveness of surgery. 16,17 Randomized controlled trials (RCTs) are considered the gold standard for evaluating the effectiveness of medical interventions.…”

“…Interlaminar endoscopic lumbar discectomy (IELD) and microscopic lumbar discectomy (MLD) are 2 prominent surgical techniques gaining traction in this context [ 11 - 13 ]. Recently, advancements in techniques and iterative improvements in instrumentation have facilitated the global adoption of MIS techniques, whether in microscopic or endoscopic surgery [ 14 , 15 ]. Innovations, such as enhanced display pixel resolution or the enhanced intraoperative navigation guidance system, have significantly increased the efficiency and effectiveness of surgery [ 16 , 17 ].…”