腰椎椎間板ヘルニアに対する内視鏡下椎間板摘出術と顕微鏡下椎間板摘出術の短期成績と2年再手術：傾向スコアマッチング解析

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.