Safety and morbidity of full-endoscopic lumbar surgery in a developing country: A comparative study of 219 cases

Full-endoscopic lumbar surgery has become an established minimally invasive alternative for treating degenerative disc disease (DDD). However, most published data originate from high-resource settings, and little is known about its morbidity profile in developing countries. This study aimed to characterize the complication patterns and perioperative outcomes of interlaminar and transforaminal lumbar endoscopy performed in a Brazilian reference center.

A retrospective, consecutive case series of 219 patients who underwent lumbar endoscopy between May 2021 and November 2024 was analyzed. Patients were divided into interlaminar (n = 112) and transforaminal (n = 107) groups. Demographic, operative, and clinical data were extracted from a prospective institutional database. Outcomes included intraoperative and postoperative complications, visual analog scale (VAS) pain scores, and paresthesia assessed by the Leeds assessment of neuropathic symptoms and signs (LANSS). Statistical analyses were performed with a 5% significance level.

Both approaches achieved significant postoperative VAS improvement (P < 0.001). Paresthesia occurred exclusively in the transforaminal group (20.6%), with a mean LANSS of 15.2 ± 4.3, all resolving spontaneously. One transient sympathetic alteration and one 30-mL epidural hematoma were managed conservatively. Two reoperations were endoscopic revisions for recurrent herniation. The transforaminal group had a higher rate of two-level surgeries (P < 0.01) and mild intraoperative nerve root injuries (P = 0.031). Hospitalization time was short and comparable between groups.

Lumbar endoscopy for DDD is a safe and effective technique in a developing-country context, with low morbidity and transient, self-limited neurological complications.