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

IF 2.6 2区医学 Q2 CLINICAL NEUROLOGY

Spine Pub Date : 2025-07-11 DOI:10.1097/BRS.0000000000005404

Alejandro Perez-Albela, Manjot Singh, Jinseong Kim, Maria Jensen, Gregory Snigur, Alan H Daniels, Bryce A Basques

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引用次数: 0

Abstract

Study design: Retrospective cohort study.

Objective: To compare intraoperative complications, 90-day medical complications, and 2-year surgical reoperation rates between endoscopic discectomy (ED) and open discectomy (OD).

Summary of background data: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

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开放与内镜下腰椎间盘切除术：2618例手术患者的倾向匹配分析。

研究设计：回顾性队列研究。目的：比较内镜下椎间盘切除术（ED）与开放式椎间盘切除术（OD）的术中并发症、90天内科并发症及2年内手术再手术率。背景资料概述：有症状的腰椎间盘突出是常见的，椎间盘切除术是一种常见的手术干预。先前比较ED和OD的研究在并发症和长期结果方面的发现不一致，通常受到样本量小和研究异质性的限制。方法：使用PearlDiver数据库对2010-2022年接受ED （CPT-62380）和OD （CPT-63030）的患者进行筛选。倾向评分匹配（1:1）控制年龄、性别和Charlson合并症指数（CCI）。结果包括术中并发症，如硬脑膜撕裂和神经损伤；90天的医疗并发症，包括深静脉血栓形成（DVT）、手术部位感染（SSI）、硬脑膜修复和尿路感染（UTI）；2年的再手术。统计分析采用卡方检验、t检验和多变量逻辑回归来调整合并症。报告了95%置信区间的优势比（OR）。结果：共有2618例患者被确诊和检查（1309例ED， 1309例OD）。在多因素分析中，ED与硬脑膜撕裂（0.15%比1.15%,OR: 0.179， P=0.006）、手术部位感染（0.08%比1.15%,OR: 0.082， P=0.001）、伤口并发症（0.38%比1.07%,OR: 0.342， P=0.023）和硬脑膜修复（0.08%比0.69%,OR: 0.091， P=0.021）的风险显著降低相关。ED还与持续疼痛的几率较低相关（2.22% vs 2.83%, OR: 0.665， P=0.048）。在神经损伤、深静脉血栓、尿路感染或再入院方面没有观察到显著差异。结论：ED与更少的硬脑膜撕裂、手术部位感染、伤口并发症和硬脑膜修复有关，与OD相比，持续疼痛的几率更低。两组间DVT、UTI和再手术发生率无显著差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Spine 医学-临床神经学

CiteScore

5.90

自引率

6.70%

发文量

361

审稿时长

6.0 months

期刊介绍： Lippincott Williams & Wilkins is a leading international publisher of professional health information for physicians, nurses, specialized clinicians and students. For a complete listing of titles currently published by Lippincott Williams & Wilkins and detailed information about print, online, and other offerings, please visit the LWW Online Store. Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.