Evaluation of Endoscopic Versus Open Lumbar Discectomy: A Multi-Center Retrospective Review Utilizing the American College of Surgeons’ National Surgical Quality Improvement Program (ACS-NSQIP) Database

Abstract

Introduction: Endoscopic techniques in spine surgery continue to gain popularity due to their potential for decreased blood loss and post-operative pain. However, limited studies have evaluated these techniques within the United States. Additionally, given the limited number of practitioners with experience in endoscopy, most current studies are limited by a lack of heterogeneity. Methods: The American College of Surgeons’ National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to evaluate the effect of endoscopic surgery on adverse events. Current Procedural Terminology (CPT) codes for open discectomy were compared with the relevant CPT codes for endoscopic lumbar discectomy. Baseline patient characteristics and adverse outcomes were then compared. Results: A total of 38,497 single-level lumbar discectomies were identified and included. Of these, 175 patients undergoing endoscopic discectomy were compared with 38,322 patients undergoing open discectomy. Endoscopic discectomy demonstrated a shorter operative time of 88.6 minutes than 92.1 minutes in the open group. However, this was not significant (p=0.08). Patients in the endoscopic group demonstrated a shorter total length of stay of 0.81 days vs 1.15 days (p=0.014). Total adverse events were lower in the endoscopic group at 0.6% vs 3.4% in the open group (p=0.03). Conclusion: Endoscopic discectomy demonstrated a significantly lower rate of adverse events and shorter total length of stay than open discectomy. Further research is necessary over time to evaluate larger patient populations as this technology is more rapidly incorporated.

Perspectives of Endoscopic Spine Surgery in Athletes and Practitioners of Physical Activity

“…This approach utilizes endoscopic visualization, and high-speed burrs [13]. A recent study demonstrated that ESS is superior to open discectomy regarding the rate of adverse events and total length of hospital stay [45]. It is possible to perform foraminoplasty and decompression of structures that may participate in the genesis of the degenerative disease of the segment approached (Figure 1) [46].…”

CORR Insights®: Reoperation Rates of Microendoscopic Discectomy Compared With Conventional Open Lumbar Discectomy: A Large-database Study

“…In patients with lumbar disc herniation, microendoscopic discectomy and open microdiscectomy are used to treat pain caused by lumbar radicular compression in patients whose symptoms persist despite medication and other nonsurgical interventions. Microendoscopic discectomy is being used more widely because it offers a shorter recovery period and its clinical results seem to be comparable to those of open microdiscectomy [2, 8], but whether the short-term benefits come at a cost in terms of longer-term problems (such as reoperations) remains unknown [4]. In particular, whether the smaller approach results in more-severe damage to the remaining disc has not been characterized, and the “microendoscopic” and “open” techniques include adaptations that have varied across studies on the topic.…”

Enhancing Transforaminal Full Endoscopic Discectomy: Efficacy of the Hand Down Outside-In (HDOI) Technique

“…While traditional open discectomy is known for its effective outcomes, the procedure's invasiveness and associated complications often result in extended recovery periods [3]. Consequently, there has been a shift toward minimally invasive techniques to reduce surgical morbidity [4].…”