Effectiveness of Full Endoscopic Spine Surgery vs. Open Surgery for Lumbar Degenerative Disease: Impact of Baseline Disease Severity

Introduction: Minimally invasive spinal surgery, including Full Endoscopic Spine Surgery (FESS), offers benefits such as fewer complications and shorter length of stay compared to traditional open surgical techniques. Several studies have demonstrated that FESS can lead to reduced postoperative pain, less blood loss, and quicker recovery times, making it an appealing option for patients suffering from lumbar degenerative spine disease. However, there remains inconsistency in the literature regarding the overall benefits of FESS compared to open surgery. This study compares the effectiveness of FESS versus open surgery for lumbar degenerative spine disease.

Methods: A single-center prospective study recruited adults undergoing open lumbar surgery for degenerative spine disease. Patients undergoing FESS were recruited through a separate multicenter prospective study. In both studies, patients were monitored remotely and Patient-reported outcomes (PROMs), including NRS leg and back pain and Oswestry Disability Index (ODI), were collected preoperatively and at 6- and 12-month post-surgery. A propensity score-matched analysis accounting for the difference in patients’ demographics, comorbidities, and operative details was conducted, and improvements in 6- and 12-month outcomes were compared between cohorts.

Results: A total of 52 patients were included (26 in the open surgery cohort, 26 in the FESS cohort, 42% female). FESS patients had significantly lower preoperative and postoperative pain and disability scores, less estimated blood loss (8.5 mL vs. 272.3 mL, p < 0.0001), and a shorter operative time (102 minutes vs. 377 minutes, p < 0.0001) compared to open surgery patients. There were no significant differences in net PROMs improvement between groups.

Conclusion : FESS provides comparable overall improvements in clinical outcomes to open surgery for lumbar degenerative spine disease. These findings underscore FESS as a viable minimally invasive alternative, However, further studies focusing on more homogenous patient populations and specific interventions are necessary to validate these findings.