Is Minimally Invasive Spinal Surgery Superior to Endoscopic Spine Surgery in Postoperative Radiologic Outcomes of Lumbar Spine Degenerative Disease? A Systematic Review

Abstract

Background: Minimally invasive spinal surgery (MISS) and endoscopic spine surgery (ESS) are both well-established surgical techniques for lumbar spinal stenosis; however, there is limited literature comparing the efficacy of the two techniques with respect to radiological decompression data. Methods: In this review, PubMed, Google Scholar, and Scopus databases were systematically searched from inception until July 2022 for studies that reported the radiological outcomes of endoscopic and minimally invasive approaches for decompressive spinal surgery, namely, the spinal canal area, neural foraminal area, and neural foraminal heights. Results: Out of the 378 papers initially retrieved using MeSH and keyword search, nine studies reporting preoperative and postoperative spinal areas and foraminal areas and height were finally included in our review. A total of 581 patients: 391 (67.30%) underwent MISS and 190 (32.70%) underwent ESS. The weighted mean difference between the canal diameter in pre-operative and post-operative conditions was 56.64 ± 7.11 mm2 and 79.52 ± 21.31 mm2 in the MISS and ESS groups, respectively. ESS was also associated with higher mean difference in the foraminal area postoperatively (72 ± 1 mm2 vs. 35.81 ± 11.3 mm2 in MISS and ESS groups, respectively) but was comparable to MISS in terms of the foraminal height (0.32 ± 0.037 vs. 0.29 ± 0.03 cm in the MISS and endoscopic groups, respectively). Conclusions: Compared to MISS, ESS was associated with improved radiological parameters, including spinal canal area and neural foraminal area in the lumbar spinal segments. Both techniques led to the same endpoint of neural decompression when starting with more severe compression. However, the present data does not allow the correlation of the radiographic results with the related clinical outcomes.

Comparative Analysis of Open Transforaminal Lumbar Interbody Fusion and Wiltse Transforaminal Lumbar Interbody Fusion Approaches for Treating Single-Level Lumbar Spondylolisthesis: A Single-Center Retrospective Study

“…Early in a surgeon's exposure to MIS TLIF, operative times may be longer, and there might be a higher reliance on fluoroscopy, leading to prolonged exposure times. Both factors could potentially elevate the risk of complications and the need for revisions [37][38][39][40][41][42].…”

Functional Outcomes of Therapeutic Selective Nerve Root Block for Single-Segment Lumbar Spinal Stenosis: A Retrospective Study

“…However, LSS symptoms and signs are often inconsistent with the imaging examination, which can be asymptomatic in some patients. The lumbar spine degenerative process is reported to be the main pathogenesis of LSS [2]. It is estimated that the prevalence of LSS is 47.2% and increases with age [3].…”

Factors affecting return to work following endoscopic lumbar foraminal stenosis surgery: A single-center series

“…[10,28,50] Endoscopic lumbar foraminotomy (ELF), as well as minimally invasive spinal surgery (MISS), led to the same endpoint of neural decompression when starting with more severe compression. [40] ELF can be performed under local or epidural anesthesia. Additional advantages include less blood loss and tissue damage.…”