Endoscopic Lumbar Decompression May Offer Advantages When Compared To Open Technique: A Longitudinal Comparative Analysis of Patient-Reported Outcomes

Introduction: Endoscopic spine surgery is advancing minimally invasive techniques by offering shorter recovery times and reduced postoperative pain compared to open procedures. While endoscopy yields comparable decompression outcomes to open surgery, differences in patient-reported outcomes (PROMs), specifically PROMIS scores, remain underexplored. This study examined within- and between-group differences in PROMs following endoscopic lumbar decompression to better understand its effectiveness relative to open surgery.

Methods: This retrospective study analyzed 220 (Endoscopic: 70; Open: 150) patients who underwent endoscopic or open lumbar intralaminar decompression at a multi-hospital academic center. Primary outcomes included Visual Analog Scale (VAS), EuroQol 5 Dimension (EQ5D), Oswestry Disability Index (ODI), PROMIS Physical Function (PF), PROMIS Pain Interference (PI), and PROMIS Depression. Linear mixed effect models (LMM) were used to investigate differences pre-operatively and post-operatively (0-1 months, 1-3 months, 3-6 months, 6-12 months, 12 months+), with P-values adjusted using the Bonferroni correction.

Results: Similar within-group significant differences were observed for all postoperative PROMs. Adjusted analysis of between-group differences using LMMs showed significant difference for the endoscopic group for VAS at 3-6 months (mean difference [MD] -1.1, P=0.005), 6-12 months (MD -1.3, P=0.002), and 12+ months (MD -0.9, P=0.021), for EQ5D at 1-3 months (MD 7.1, P=0.001) and 6-12 months (MD 6.0, P=0.004), for ODI at 1-3 months (MD -4.1, P=0.042) and 6-12 months (MD -3.9, P=0.049), for PROMIS PF at 3-6 months (MD -3.3, P< 0.001), and for PROMIS PI at 0-1 months (MD -2.0, , P=0.028), at 1-3 months (MD -2.6, P=0.003, and at 6-12 months (MD -3.1, P< 0.001). The were no significant differences between-group for all other PROMs and time-points.

Conclusion : Endoscopic lumbar decompression demonstrated advantages over open surgery, yielding greater reductions in pain and improved functional recovery across key postoperative periods. These results reinforce endoscopic techniques as an effective, minimally invasive option in spine surgery, supporting its broader adoption.