Complications and Cost in Open Versus Endoscopic Lumbar Decompression: A Database Study

Area of Science:

• Neurosurgery
• Spinal Surgery
• Minimally Invasive Procedures

Background:

• Open lumbar decompression is the established standard, but endoscopic techniques are increasingly utilized.
• Limited comparative studies exist, primarily small-scale or conducted internationally.
• This study addresses the need for large-scale data on endoscopic vs. open lumbar decompression outcomes.

Purpose of the Study:

• To compare complications and costs of endoscopic and open lumbar decompression.
• To evaluate the rate of repeat lumbar surgeries within two years for both procedures.

Main Methods:

• Retrospective analysis of the PearlDiver database (2017-2021).
• Inclusion of single-level lumbar decompression cases with 2-year follow-up.
• Exclusion of multilevel surgery, fusion, or other spinal procedures.
• Comparison of postoperative complications (infection, dehiscence, dural tear), costs, and reoperation rates.

Main Results:

• 103,153 patients included (895 endoscopic, 102,258 open).
• Similar rates of infection, wound dehiscence, and dural tear between groups.
• Endoscopic decompression had slightly higher total 2-year costs ($20,347 vs. $18,089).
• Endoscopic decompression patients were over twice as likely to require a second lumbar surgery within 2 years (16% vs. 7%).

Conclusions:

• Endoscopic and open lumbar decompression exhibit comparable complication and cost profiles.
• A significantly higher rate of repeat surgery is observed in patients undergoing endoscopic decompression.
• Prospective studies are warranted to elucidate the drivers of additional surgical procedures.