Postoperative complications and mechanical outcomes following endoscopic versus open lumbar fusion: A propensity-matched analysis

IF 3.2 Q3 Medicine

North American Spine Society Journal Pub Date : 2026-03-01 Epub Date: 2026-01-21 DOI:10.1016/j.xnsj.2026.100855

Ryan Wang BS , William Zeng BS , Alexander T. Hong BS , Hannah Cho BS , Syed I. Khalid MD , Ankit I. Mehta MD

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Abstract

Background

Endoscopic lumbar fusion has emerged as a minimally invasive alternative to traditional open fusion, yet large-scale comparative evidence on postoperative safety and long-term effectiveness remains limited. This study evaluated national real-world outcomes following endoscopic versus open lumbar fusion.

Methods

A retrospective cohort study was performed using the TriNetX US Collaborative Network. Adult patients undergoing endoscopic and open lumbar fusion were identified using ICD-10-PCS codes. Propensity score matching (1:1) generated 2 balanced cohorts (n=23,723 each). Ninety-day medical and surgical complications were compared using odds ratios (ORs) with 95% confidence intervals (CIs). One-year and 2-year pseudoarthrosis, instrumentation failure, and revision surgery were evaluated using risk ratios (RRs) with 95% CIs. Statistical significance was set at p<.05.

Results

Endoscopic fusion demonstrated higher 90-day rates of UTI (OR: 1.20, 95% CI, 1.06–1.35, p=.003) and pneumonia (OR: 1.22, 95% CI, 1.01–1.47, p=.043). Among surgical outcomes, endoscopic fusion had higher post-operative hematoma (OR: 1.42, 95% CI, 1.05–1.92, p=.023) and SSI (OR: 1.36, 95% CI, 1.20–1.54, p<.001), but lower wound complications (OR: 0.94, 95% CI, 0.79–1.11, p=.461) and CSF leak (OR: 0.59, 95% CI, 0.45–0.78, p<.001). At one year, endoscopic fusion showed higher pseudoarthrosis (13.5% vs. 6.4%, RR: 2.10, 95% CI, 1.99–2.22, p<.001), whereas rates of revision surgery were not significantly different (0.70% vs. 0.62%, RR: 1.14, 95% CI, 0.92–1.40, p=.231). Instrumentation failure remained lower (0.09% vs. 0.30%, RR: 0.31, 95% CI, 0.19–0.49, p<.001). At 2 years, pseudoarthrosis (18.9% vs. 8.8%, p<.001) remained higher, instrumentation failure remained lower (0.2% vs. 0.65%, p<.001), and revision surgery occurred at similar rates (1.60% vs. 1.60%, p=.994).

Conclusions

Endoscopic lumbar fusion was associated with higher rates of several medical and infection-related complications, as well as significantly higher pseudoarthrosis at 1 and 2 years, while demonstrating lower instrumentation failure. These findings highlight distinct risk profiles between techniques and emphasize the importance of patient selection and continued refinement of endoscopic fusion approaches.

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内镜下与开放式腰椎融合术的术后并发症和机械结果：倾向匹配分析。

背景：内镜腰椎融合术已成为传统开放融合术的微创替代方法，但关于术后安全性和长期有效性的大规模比较证据仍然有限。本研究评估了内镜下与开放式腰椎融合术后的全国实际结果。方法：采用TriNetX美国协作网络进行回顾性队列研究。采用ICD-10-PCS编码对接受内镜和开放式腰椎融合的成年患者进行鉴定。倾向评分匹配（1:1）生成2个平衡队列（n=23,723）。使用95%可信区间（ci）的优势比（ORs）比较90天内的内科和外科并发症。使用95% ci的风险比（rr）评估1年和2年假关节、内固定失败和翻修手术。结果：内镜融合显示更高的90天UTI发生率（OR: 1.20, 95% CI, 1.06-1.35, p= 0.003）和肺炎发生率（OR: 1.22, 95% CI, 1.01-1.47, p= 0.043）。在手术结果中，内窥镜融合术术后血肿（OR: 1.42, 95% CI, 1.05-1.92, p= 0.023）和SSI （OR: 1.36, 95% CI, 1.20-1.54）较高。结论：内窥镜腰椎融合术与几种医学和感染相关并发症发生率较高相关，1年和2年假关节发生率明显较高，同时内固定失败发生率较低。这些发现突出了不同技术之间不同的风险特征，并强调了患者选择和内镜融合入路持续改进的重要性。

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