Long-Term Risk of Subsequent Cervical Fusion After Endoscopic Versus Open Cervical Decompression.

Abstract

Study DesignRetrospective cohort study.ObjectiveEndoscopic cervical decompression (ECD) has emerged as a minimally invasive alternative to open cervical decompression, but large-scale comparative data evaluating short-term safety and long-term reoperation remain limited.MethodsA retrospective cohort study was performed using the TriNetX Global Collaborative Network for adults undergoing endoscopic or open cervical decompression. Thirty-day medical, surgical, and healthcare utilization outcomes were evaluated. Time-to-fusion was analyzed with Kaplan-Meier curves and Cox proportional hazards ratios.ResultsAfter matching, 17 251 ECD patients were included in each cohort. Thirty-day medical (2.8% vs 3.0%; <i>P</i> = 0.31) and surgical complications (1.8% vs 1.9%; <i>P</i> = 0.20) were similar. Hospital readmission occurred less frequently after ECD (2.8% vs 3.9%; RR 0.72, 95% CI 0.64-0.80; <i>P</i> < 0.001), while ED visits were comparable (3.3% vs 3.3%; RR 0.99, 95% CI 0.88-1.11; <i>P</i> = 0.83). Long-term outcomes showed a significant elevation in subsequent cervical fusion after ECD from 1 to 5 years (log-rank <i>P</i> < 0.001). At 1 year, fusion occurred in 4.2% of ECD patients vs 2.7% of open patients (HR 1.55, 95% CI 1.37-1.75; <i>P</i> < 0.001). At 5 years, cumulative fusion incidence reached 5.9% vs 3.9% (HR 1.48, 95% CI 1.34-1.64; <i>P</i> < 0.001). In a contemporary-era sensitivity analysis (2021-2024), findings remained directionally consistent at 1 and 2 years, although statistical significance was not reached.ConclusionECD offers comparable perioperative safety and lower readmission but carries a higher long-term risk of subsequent cervical fusion, highlighting the importance of counseling patients regarding potential reoperation risk.