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Evaluation of Endoscopic Versus Open Lumbar Discectomy

By Admin | June 01, 2022


Introduction: Endoscopic techniques in spine surgery continue to gain popularity due to their potential for decreased blood loss and post-operative pain. However, limited studies have evaluated these techniques within the United States. Additionally, given the limited number of practitioners with experience in endoscopy, most current studies are limited by a lack of heterogeneity.

Methods: The American College of Surgeons’ National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to evaluate the effect of endoscopic surgery on adverse events. Current Procedural Terminology (CPT) codes for open discectomy were compared with the relevant CPT codes for endoscopic lumbar discectomy. Baseline patient characteristics and adverse outcomes were then compared. 

Results: A total of 38,497 single-level lumbar discectomies were identified and included. Of these, 175 patients undergoing endoscopic discectomy were compared with 38,322 patients undergoing open discectomy. Endoscopic discectomy demonstrated a shorter operative time of 88.6 minutes than 92.1 minutes in the open group. However, this was not significant (p=0.08). Patients in the endoscopic group demonstrated a shorter total length of stay of 0.81 days vs 1.15 days (p=0.014). Total adverse events were lower in the endoscopic group at 0.6% vs 3.4% in the open group (p=0.03).

Conclusion: Endoscopic discectomy demonstrated a significantly lower rate of adverse events and shorter total length of stay than open discectomy. Further research is necessary over time to evaluate larger patient populations as this technology is more rapidly incorporated.


Lumbar radiculopathy is a common clinical pathology with a lifetime incidence ranging from 13% to 40% and is associated with significant morbidity and socioeconomic burden [1]. In cases where conservative therapy fails, discectomy is the standard surgical care. The first lumbar discectomy ever performed was conducted by Fedor Krause in 1908 [2]. Since then, perpetual technologic advancements have pushed the procedure to increasingly more minimally invasive options to reduce postoperative pain and minimize surrounding tissue disruption [3,4].

Most recently, the use of endoscopic technology has become more commonly utilized in the United States. Despite reports of its success and noninferiority abroad, little research comparing endoscopic discectomy compared to traditional open microdiscectomy has been conducted in the United States [5]. Given the relatively small number of practitioners using this technology, large studies comparing outcomes have been difficult to generalize. Here, we evaluated the American College of Surgeons National Surgical Quality Improvement (NSQIP) database to evaluate the nationwide experience of endoscopic discectomy (ED) compared with traditional open discectomy (OD) to evaluate the generalizability of this procedure and its outcomes. Our results are then compared to the known relevant medical literature.

Materials & Methods

A retrospective review was conducted of the ACS-NSQIP database for the years 2017 to 2020 containing data from over 700 hospitals both nationally and internationally [6]. The year 2017 was chosen as it was the first year in which a separate Current Procedural Terminology (CPT) code was available for endoscopic (ED) procedures. Patients were then selected based upon...(More)

For more info please read, Evaluation of Endoscopic Versus Open Lumbar Discectomy, by Cureus

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