Minimally invasive tubular decompression versus traditional open surgery for lumbar spinal stenosis: a systematic...

Minimally invasive (MI) tubular decompression seeks to reduce soft‑tissue trauma compared with open laminectomy for lumbar spinal stenosis (LSS). We performed a PRISMA‑compliant systematic review and meta‑analysis of comparative studies (2015-April 2025) identified in PubMed, Embase, and CENTRAL. Adults with symptomatic degenerative LSS undergoing MI tubular decompression or open laminectomy were included. Evaluated outcomes included surgical parameters (e.g., overall complications; dural tears, surgical site infections, reoperation), perioperative and postoperative complications, patient-reported outcome measures (PROMs), and hospital length of stay (LOS). Heterogeneity was measured using I². Random-effects models were primary; PROMs were also analyzed in a common-effect sensitivity analysis. Nine studies involving ten cohorts and a total of 2,860 patients were analyzed from 2,853 records. Random-effects models pooled odds ratios (OR) and mean differences (MD); PROMs were additionally examined with a common-effect model as a sensitivity analysis. MI tubular surgery was associated with fewer overall complications (OR 0.42, 95% CI 0.21-0.86), fewer surgical site infections (OR 0.28, 95% CI 0.11-0.69), lower EBL (MD - 46.65 mL, 95% CI - 80.89 to - 12.41), and shorter LOS (MD - 1.39 days, 95% CI - 1.99 to - 0.79). Reoperation, operative time, dural tears, and PROMs did not differ significantly. Overall, our results suggest that MI tubular-assisted decompression may offer advantages over open surgery for lumbar spinal stenosis. It was associated with lower perioperative morbidity and resource utilization - including lower overall complication rates, fewer surgical-site infections, reduced blood loss, and shorter hospital stays - while achieving similar patient-reported outcomes. Given between-study heterogeneity and the predominance of retrospective cohorts, these results should be interpreted with appropriate caution; nevertheless, when feasible and in appropriately selected patients and settings, tubular-assisted decompression may be considered a preferable option.