Full-endoscopic versus microscopic spinal decompression for lumbar spinal stenosis: a systematic review &...

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Minimally Invasive Procedures

Background:

• Symptomatic lumbar spinal stenosis is commonly treated with spinal decompression surgery.
• Minimally invasive techniques, such as endoscopic decompression, are increasingly favored for reduced approach-related morbidity.
• Endoscopic decompression shows comparable clinical outcomes to traditional open or microscopic methods.

Purpose of the Study:

• To evaluate the safety and efficacy of endoscopic decompression compared to microscopic decompression for lumbar spinal stenosis.

Main Methods:

• A systematic review and meta-analysis of randomized and nonrandomized studies were performed.
• Studies were identified following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
• Risk of bias and evidence quality were assessed using established tools (Cochrane, ROBINS-I, GRADE).

Main Results:

• The review included 19 studies with 1,997 patients and 2,132 spinal levels.
• Endoscopic decompression demonstrated significantly lower intraoperative blood loss, shorter hospital stays, and reduced rates of incidental durotomy and surgical site infections.
• A trend towards less pain and better functional outcomes was observed with endoscopic decompression, though not statistically significant at 2-year follow-up.

Conclusions:

• Both endoscopic and microscopic decompression are safe and effective for symptomatic lumbar spinal stenosis.
• Further high-powered prospective studies are needed to compare medium- to long-term outcomes, including iatrogenic instability and alignment changes.