Short-Term Outcomes and 2-Year Reoperations Following Endoscopic versus Microdiscectomy for Lumbar Disc Herniation: A Propensity-Matched Analysis.

Abstract

Endoscopic lumbar discectomy has gained popularity as a minimally invasive alternative to microdiscectomy, yet large-scale comparative data evaluating postoperative durability remain limited. This study assessed short-term complications and 2-year reoperation rates between endoscopic and microdiscectomy cohorts using a large multicenter database. A retrospective cohort analysis was performed using the TriNetX US Collaborative Network. Adult patients undergoing endoscopic discectomy or microdiscectomy for lumbar disc herniation were identified using Current Procedural Terminology codes. A 1:1 propensity score matching was performed for demographics and baseline comorbidities. Ninety-day medical and surgical complications, hospital readmission, and emergency department utilization were evaluated using risk ratios (RRs). Two-year repeat lumbar decompression, subsequent lumbar fusion, and postlaminectomy syndrome were analyzed using Cox proportional hazards models. At 90 days, composite medical complications were significantly lower following endoscopic discectomy compared with microdiscectomy (2.3% vs. 3.7%; RR 0.61, 95% confidence interval (CI) 0.41-0.93; P=0.020), as were composite surgical complications (0.9% vs. 2.5%; RR 0.37, 95% CI 0.20-0.68; P=0.001). Hospital readmission and emergency department visits were not significantly different (P>0.05). At two years, endoscopic discectomy was associated with a higher risk of repeat lumbar decompression (8.3% vs. 4.3%; hazard ratio 2.03, 95% CI 1.45-2.83; P<0.001) and postlaminectomy syndrome (4.5% vs. 3.1%; hazard ratio 1.58, 95% CI 1.08-2.30; P=0.018). Subsequent lumbar fusion rates were low and comparable between groups (3.5% vs. 3.3%; P=0.595). Endoscopic lumbar discectomy offers improved perioperative safety but reduced 2-year durability compared with microdiscectomy, highlighting the need to balance short-term advantages with long-term reoperation risk.