Minimally invasive lumbar decompression versus open decompression for lumbar spinal stenosis: a propensity...

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Surgery

Background:

• Lumbar spinal stenosis affects hundreds of thousands of Americans annually.
• Minimally invasive lumbar decompression (mild) was developed as a less invasive alternative to open decompression.
• Concerns exist regarding industry-sponsored data for the mild procedure.

Purpose of the Study:

• To compare real-world clinical outcomes of the mild procedure versus open decompression for lumbar spinal stenosis.
• To evaluate differences in pain improvement, reoperation rates, and perioperative complications.

Main Methods:

• Retrospective study of patients undergoing mild or open decompression at a single tertiary care center (2005-2024).
• One-to-one propensity score matching used covariates including age, sex, smoking, and comorbidities.
• Primary outcomes: change in Numeric Rating Scale (NRS) pain, reoperation, and perioperative complications. Minimal clinically important difference (MCID) defined as 30% NRS improvement.

Main Results:

• 175 patients in each group (mild vs. open decompression) were matched.
• Open decompression patients were more likely to achieve MCID for pain (43.1% vs. 22.2%, p < 0.001).
• Mild procedure group had higher reoperation rates (46.2% vs. 29.3%, p = 0.008) and neurological deficits (6.3% vs. 0.6%, p = 0.003), but lower durotomy rates (0% vs. 2.9%, p = 0.024).

Conclusions:

• Open decompression is more effective for pain improvement in symptomatic lumbar stenosis patients.
• Open decompression is associated with a lower likelihood of requiring reoperation compared to the mild procedure.