Complications in endoscopic spine surgery: a systematic review

Area of Science:

• Minimally Invasive Spine Surgery
• Surgical Complications
• Endoscopic Spine Procedures

Background:

• Endoscopic spine surgery offers a minimally invasive approach.
• Understanding complication profiles is crucial for patient safety and procedure optimization.
• Stratification by technique, spinal region, and procedure type is needed.

Purpose of the Study:

• To systematically review and analyze complication rates of endoscopic spine surgeries.
• To stratify complications based on surgical technique (uniportal vs. biportal), spinal district (cervical, thoracic, lumbar), and procedure type (discectomy/decompression vs. fusion).

Main Methods:

• Systematic review adhering to PRISMA guidelines.
• Comprehensive literature search across multiple databases (MEDLINE, EMBASE, etc.).
• Inclusion of observational studies and randomized controlled trials; exclusion of reviews and abstracts. Data extraction on perioperative and late complications.

Main Results:

• Analysis included 117 articles covering 20,020 patients (10,405 UESS, 9615 UBESS).
• Uniportal full-endoscopic spine surgery (UESS) and unilateral biportal endoscopic spine surgery (UBESS) were compared.
• Complication data were analyzed in subgroups with at least 100 patients for statistical validity.

Conclusions:

• Perioperative complications (e.g., dural tear, transient neurological deficit) are significant in endoscopic discectomy and decompression.
• Late complications, notably mechanical implant failure, are more prevalent in endoscopic interbody fusion procedures.
• Findings provide insights into the risk profiles of different endoscopic spine surgery techniques and procedures.