Resultados a Corto Plazo y Reoperaciones a Dos Años Tras Endoscopia Versus Microdiscectomía para Hernia Discal...

Endoscopic lumbar discectomy has gained popularity as a minimally invasive alternative to microdiscectomy, yet large-scale comparative data evaluating postoperative durability remain limited. This study assessed short-term complications and two-year reoperation rates between endoscopic and microdiscectomy cohorts using a large multicenter database.

A retrospective cohort analysis was performed using the TriNetX US Collaborative Network. Adult patients undergoing endoscopic discectomy or microdiscectomy for LDH were identified using CPT codes. A 1:1 propensity score matching was performed for demographics and baseline comorbidities. Ninety-day medical and surgical complications, hospital readmission, and ED utilization were evaluated using risk ratios. Two-year repeat lumbar decompression, subsequent lumbar fusion, and post-laminectomy syndrome were analyzed using Cox proportional hazards models.

At 90 days, composite medical complications were significantly lower following endoscopic discectomy compared with microdiscectomy (2.3% vs 3.7%; RR 0.61, 95% CI 0.41-0.93; p = 0.020), as were composite surgical complications (0.9% vs 2.5%; RR 0.37, 95% CI 0.20-0.68; p = 0.001). Hospital readmission and ED visits were not significantly different (p > 0.05). At two years, endoscopic discectomy was associated with a higher risk of repeat lumbar decompression (8.3% vs 4.3%; HR 2.03, 95% CI 1.45-2.83; p < 0.001) and post-laminectomy syndrome (4.5% vs 3.1%; HR 1.58, 95% CI 1.08-2.30; p = 0.018). Subsequent lumbar fusion rates were low and comparable between groups (3.5% vs 3.3%; p = 0.595).

Endoscopic lumbar discectomy offers improved perioperative safety but reduced two-year durability compared with microdiscectomy, highlighting the need to balance short-term advantages with long-term reoperation risk.