Lumbar endoscopic discectomy versus minimally invasive microdiscectomy: a retrospective cost-effectiveness study

Lumbar endoscopic discectomy (LED) is an increasingly common minimally invasive procedure used in treating lumbar disc herniation and decompressing spinal nerves. Various techniques have been described, each offering improved intraoperative visualisation and safety profile yet maintaining smaller incisions, resulting in better surgical outcomes and shorter hospital stay, as compared to minimally invasive microdiscectomy (MISD). This study aimed to investigate the cost-effectiveness of LED (uniportal and biportal approaches) against conventional MISD.

This is a single-centre, multi-surgeon, retrospective case cohort study of 24 and 18 patients who underwent elective single-level uniportal LED and biportal LED, respectively. In addition, an age-matched group of 42 patients who underwent single-level MISD was included. Patient demographics (age, gender, body mass index, Charlson Comorbidity Index and Functional Independence Measure), 6-month postoperative complications and inpatient hospitalisation costs were compared.

Both uniportal and biportal endoscopic discectomy groups had significantly higher operation durations but maintained comparable hospital length of stay, and intra- and postoperative complication rates. The uniportal group had significantly higher overall inpatient hospitalisation bill compared to the biportal and MISD groups due to the rental fee for specialised endoscopic equipment.

The biportal endoscopic approach - due to its equipment versality - has lower equipment costs than uniportal endoscopic discectomy. For the biportal approach to potentially become a cost-effective and safe alternative to conventional MISD, a learning curve remains for surgeons and institutions to overcome in order to achieve shorter hospital stays and operative durations.