Postoperative opioid utilization following uniportal endoscopic versus open microscopic lumbar discectomy

Symptomatic lumbar disc herniation refractory to nonoperative management may be treated by traditional open lumbar microdiscectomy or by emerging alternative approaches such as endoscopic discectomy. Although the smaller incision and lesser degree of iatrogenic tissue disruption afforded by endoscopy are hypothesized to minimize postoperative pain, there is a paucity of studies that have evaluated this outcome.

This study was a retrospective cohort study at a single surgical center affiliated with an academic practice. All patients undergoing single-level lumbar discectomy between 2021 and 2024 were retrospectively identified and stratified into cohorts by approach taken (open or endoscopic). Baseline comorbidities and postsurgical outcomes were collected from the medical record, and opioid use data were retrieved from the state Prescription Drug Monitoring Program. Clinical outcomes, postoperative opioid usage by time, and cumulative opioid usage by morphine milligram equivalents (MME) between the two cohorts were compared using the 2-sided t-test for continuous variables and the chi-square test of independence for categorical variables.

One hundred ninety-one patients met the criteria for analysis, of whom 91 (47.6%) underwent endoscopic and 100 (52.4%) underwent open procedures. Patients who underwent endoscopic procedures experienced lower rates of persistent opioid use at postoperative week 6 compared with those who underwent open procedures (8.8% vs 21.0%; relative risk 0.47, p = 0.035) as well as lower average cumulative opioid use by MME (264.7 vs 340.5, p = 0.017). Rates and the amount of opioid usage beyond 6 weeks were not significantly different between groups. Similarly, rates of outcomes such as reduction in leg pain, reoperation, durotomy, and operative time were similar between the groups.

In this retrospective analysis, endoscopic lumbar discectomy was associated with lower short-term postoperative opioid utilization while conferring clinical outcomes similar to those of traditional open microdiscectomy. These results are limited by individual variation in opioid-prescribing practices by individual center, and future studies with standardized opioid-prescription protocols will improve the external validity of these findings.