Outcomes Following Endoscopic Versus Open Single-Level Lumbar Discectomy

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Objective: Traditional open discectomy has long been the standard treatment for lumbar disc herniation, but minimally invasive endoscopic approaches are increasingly being adopted. However, comprehensive comparative analyses of these techniques in terms of clinical outcomes remain limited. This study aimed to compare the short-term clinical outcomes of endoscopic versus open single-level lumbar discectomy, with the hypothesis that the endoscopic approach reduces postoperative complications within 1 month of surgery.Methods: This retrospective cohort study used data from the MARINER database, covering January 2017 to October 2022. Adult patients aged 18 to 74 years who underwent single-level lumbar discectomy were included. A total of 243,684 patients were identified (1,470 endoscopic and 242,214 open surgical procedures). A 1:3 propensity score matching was performed based on age, sex, Charlson Comorbidity Index, and selected comorbidities, yielding a balanced cohort of 5,640 patients (1,416 endoscopic; 4,224 open).Results: After matching, the demographic and comorbidity profiles of the 2 groups were well balanced. The endoscopic group demonstrated significantly lower rates of surgical site infections (0.35% vs. 0.95%, p<0.05; odds ratio [OR], 2.69; 95% confidence interval [CI], 1.06–6.85), surgical complications (0.71% vs. 1.52%, p<0.05; OR, 2.16; 95% CI, 1.11–4.17), and 30-day readmissions (2.47% vs. 7.65%, p<0.05; OR, 3.09; 95% CI, 2.19–4.36). Kaplan-Meier survival analysis over 18 months revealed no significant difference in the probability of subsequent lumbar fusion between groups (log-rank test p=0.8).Conclusion: Endoscopic single-level lumbar discectomy is associated with fewer short-term complications compared with open surgery. These findings support the consideration of endoscopic techniques as a lower-risk alternative for appropriately selected patients. Further studies are needed to evaluate long-term outcomes.

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