Full-Endoscopic Lumbar Decompression versus Open Decompression and Fusion Surgery for the Lumbar Spinal Stenosis: A 3-Year Follow-Up Study

Qingpeng Song; Bin Zhu; Wenkui Zhao; Chen Liang; Bao Hai; Xiaoguang Liu

doi:10.2147/JPR.S309693

Full-Endoscopic Lumbar Decompression versus Open Decompression and Fusion Surgery for the Lumbar Spinal Stenosis: A 3-Year Follow-Up Study

J Pain Res. 2021 May 20:14:1331-1338. doi: 10.2147/JPR.S309693. eCollection 2021.

Authors

Qingpeng Song^#¹, Bin Zhu^#², Wenkui Zhao^#³, Chen Liang³, Bao Hai¹, Xiaoguang Liu¹

Affiliations

¹ Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China.
² Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
³ Pain Medicine Center, Peking University Third Hospital, Beijing, People's Republic of China.

^# Contributed equally.

Abstract

Purpose: Compare the efficacy of full-endoscopic lumbar decompression surgery (FELDS) and open decompression and fusion surgery (ODFS) for lumbar spinal stenosis (LSS).

Patients and methods: A retrospective analysis of 358 LSS patients treated by FELDS ("FELD" group) or ODFS ("open" group) was undertaken. There were 177 patients in the FELDS group with a mean age of 65.47±9.26 years and 181 patients in the open group with a mean age of 64.18±10.24 years. Duration of follow-up was 38.63±11.88 months in the FELDS group and 38.56±12.29 months in the open group. Visual analog scale (VAS) score, Oswestry Disability Index (ODI), and Modified MacNab criteria were used to access clinical outcomes. Surgical outcomes (duration of surgical procedure, blood loss, complications, duration of postoperative hospital stay (DOPHS), prevalence of revision procedures) were evaluated. Magnetic resonance imaging was used to evaluate the change in the Pfirrmann grade at adjacent segments.

Results: VAS score (leg and back) and ODI improved significantly in both groups (P<0.001). Success rate reached 86.55% and 90.60% in the FELDS group and open group (P>0.05), respectively. Procedure duration (84.12 vs 112.08 min), blood loss (7.97 vs 279.67 mL), and DOPHS (2.68 vs 4.78 days) of the FELDS group were significantly better than those of the open group (P<0.05). Total prevalence of complications and procedure revisions was 14.69% and 10.73% in the FELD group, respectively, but did not show a significant difference with that in the open group (12.15% and 9.39%, respectively). The Pfirrmann grade increased in 13.04% of adjacent segments in the FELDS group, significantly better than that in the open group (32.67%) (P<0.05).

Conclusion: FELDS had the same efficacy as ODFS for LSS treatment. FELDS had the advantages of minimal invasiveness, less surgical trauma, rapid recovery, and lower risk of degeneration of adjacent segments compared with that of ODFS.

Keywords: adjacent segments degeneration; clinical outcome; full-endoscopic lumbar decompression; fusion; lumbar spinal stenosis.

Grants and funding

This study was funded by Peking University Third Hospital Key Clinical Program (Code: BYSYZD2019001) and Beijing Municipal Science and Technology Commission (Code: 2020-2-4091).