Full-endoscopic versus microscopic spinal decompression for lumbar spinal stenosis: a systematic review & meta-analysis

Brian Zhaojie Chin; Jung Hahn Yong; Eugene Wang; Seth Ian Sim; Shuxun Lin; Pang Hung Wu; Hwee Weng Dennis Hey

doi:10.1016/j.spinee.2023.12.009

Full-endoscopic versus microscopic spinal decompression for lumbar spinal stenosis: a systematic review & meta-analysis

Spine J. 2024 Jan 6:S1529-9430(24)00005-6. doi: 10.1016/j.spinee.2023.12.009. Online ahead of print.

Authors

Brian Zhaojie Chin¹, Jung Hahn Yong², Eugene Wang², Seth Ian Sim³, Shuxun Lin⁴, Pang Hung Wu⁵, Hwee Weng Dennis Hey⁶

Affiliations

¹ Department of Orthopaedic Surgery, National University Hospital, 1E Kent Ridge Rd, 119228, Singapore; Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block Level 10, 1E Kent Ridge Rd, 119228, Singapore. Electronic address: brianchinzj@gmail.com.
² Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block Level 10, 1E Kent Ridge Rd, 119228, Singapore.
³ Department of Orthopaedic Surgery, National University Hospital, 1E Kent Ridge Rd, 119228, Singapore.
⁴ Department of Orthopaedic Surgery, Ng Teng Fong General Hospital, 1 Jurong East St 21, 609606, Singapore; Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block Level 10, 1E Kent Ridge Rd, 119228, Singapore.
⁵ Department of Orthopaedic Surgery, Ng Teng Fong General Hospital, 1 Jurong East St 21, 609606, Singapore.
⁶ Department of Orthopaedic Surgery, National University Hospital, 1E Kent Ridge Rd, 119228, Singapore; Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block Level 10, 1E Kent Ridge Rd, 119228, Singapore.

PMID: 38190892
DOI: 10.1016/j.spinee.2023.12.009

Abstract

Background context: Symptomatic lumbar spinal stenosis is routinely treated with spinal decompression surgery, with an increasing trend towards minimally invasive techniques. Endoscopic decompression has emerged as a technique which minimizes approach-related morbidity while achieving similar clinical outcomes to conventional open or microscopic approaches.

Purpose: To assess the safety and efficacy of endoscopic versus microscopic decompression for treatment of lumbar spinal stenosis.

Study design: Systematic review and meta-analysis.

Methods: A systematic review on randomized and nonrandomized studies comparing endoscopic versus microscopic decompression was conducted, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Treatment effects were computed using pairwise random-effects meta-analysis. Risk of bias was assessed using the Cochrane Risk-of-bias and ROBINS-I tools for randomized and nonrandomized trials respectively. Quality of the overall body of evidence was appraised using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.

Results: A total of 19 primary references comprising 1,997 patients and 2,132 spinal levels were included. Endoscopic decompression was associated with significantly reduced intraoperative blood-loss (weighted mean differences [WMD]=-33.29 mL, 95% CI:-51.80 to -14.78, p=.0032), shorter duration of hospital stay (WMD=-1.79 days, 95% CI: -2.63 to 0.95, p=.001), rates of incidental durotomy (RR = 0.63, 95% CI: 0.43 to 0.91, p=.0184) and surgical site infections (RR=0.23, 95% CI: 0.10 to-0.51, p=.001), and a nonsignificant trend towards less back pain, leg pain, and better functional outcomes compared to its microscopic counterpart up to 2-year follow up.

Conclusions: Endoscopic and microscopic decompression are safe and effective techniques for treatment of symptomatic lumbar spinal stenosis. Prospective studies of larger power considering medium to long-term outcomes and rates of iatrogenic instability are warranted to compare potential alignment changes and destabilization from either techniques.

Keywords: Endoscopic; Lumbar spinal stenosis; Meta-analysis; Microscopic; Minimally invasive; Spinal decompression surgery; Systematic review.

Publication types

Review