Open versus Endoscopic Lumbar Discectomy: A Propensity-Matched Analysis of 2,618 Surgical Patients.

Abstract

Retrospective cohort study. To compare intraoperative complications, 90-day medical complications, and 2-year surgical reoperation rates between endoscopic discectomy (ED) and open discectomy (OD). Symptomatic lumbar disc herniation is common, with discectomy serving as a common surgical intervention. Previous studies comparing ED and OD show inconsistent findings regarding complications and long-term outcomes, often limited by small sample sizes and study heterogeneity. Patients undergoing ED (CPT-62380) and OD (CPT-63030) from 2010-2022 were identified using PearlDiver database. Propensity score matching (1:1) controlled for age, gender, and Charlson Comorbidity Index (CCI). Outcomes included intraoperative complications such as dural tears and nerve injuries; 90-day medical complications including deep vein thrombosis (DVT), surgical site infections (SSI), dura repair, and urinary tract infections (UTI); and 2-year reoperations. Statistical analyses utilized chi-square tests, t-tests, and multivariate logistic regression adjusting for comorbidities. Odds ratios (OR) with 95% confidence intervals were reported. A total of 2,618 patients were identified and examined (1,309 ED, 1,309 OD). On multivariate analysis, ED was associated with a significantly lower risk of dural tears (0.15% vs. 1.15%, OR: 0.179, P=0.006), surgical site infections (0.08% vs. 1.15%, OR: 0.082, P=0.001), wound complications (0.38% vs. 1.07%, OR: 0.342, P=0.023), and dura repair (0.08% vs. 0.69%, OR: 0.091, P=0.021). ED was also associated with lower odds of persistent pain (2.22% vs 2.83%, OR: 0.665, P=0.048). No significant differences were observed in nerve injuries, DVT, UTI, or readmissions. ED is associated with fewer dural tears, surgical site infections, wound complications, and dura repairs, along with lower odds of persistent pain compared to OD. Rates of DVT, UTI, and reoperations were not significantly different between groups.