Minimally Invasive Lumbar Decompression: Do Endoscopic Techniques Make a Difference in Recurrence?

Introduction: Tubular minimally invasive surgery (MIS) and endoscopic techniques have been increasingly used for lumbar decompression surgery. These techniques are popular for their minimally invasive nature and decreased recovery compared to traditional open surgery. However, it is not yet clear how they compare in terms of radiographic recurrence. This study investigates the risk of radiographic recurrence and need for reoperation following MIS and endoscopic lumbar decompression.

Methods: We retrospectively reviewed endoscopic lumbar spine surgeries performed at our tertiary care center from 2023-2024 (n=81) and collected data on 101 MIS surgeries between 2021-2024 to serve as a comparison group. We collected data on radiographic recurrence and reoperation rates. Statistics were conducted with SPSS.

Results: Eighty-one endoscopic and 101 MIS patients had data on radiographic recurrence at 3 months postoperatively. Endoscopic and MIS patients did not significantly differ in rate of recurrence (X2=0.659, p=0.417) nor did they differ in reoperation rates for recurrence (X2=0.087, p=0.768). Nineteen percent of endoscopic and 12% of MIS patients had evidence of radiographic recurrence while reoperation occurred at a rate of 4.9% in endoscopic and 4.9% in MIS. Additionally, when stratifying the data by type of procedure, discectomy versus laminectomy, MIS and endoscopic patients showed similar rates of recurrence (patients undergoing laminectomy X2=0.001, p=0.970, patients undergoing discectomy X2=0.425, p=0.514) and reoperation (laminectomy only X2=0.015, p=0.903, discectomy only X2=0.000, p=0.986).

Conclusion : For MIS and endoscopic spine surgery, rates of recurrence and reoperation following lumbar decompression are similar. The procedure, laminectomy versus discectomy, also does not significantly impact recurrence or need for reoperation. Neither surgical technique, endoscopic versus MIS, nor procedure, laminectomy versus discectomy, appear to be important factors when assessing the risk of recurrence and the need for reoperation in lumbar decompressions.