Complications and Cost in Open Versus Endoscopic Lumbar Decompression: A Database Study

Lauren M Boden; Susanne H Boden; Najib Muhammad; Matthew A Kanzler; David S Casper

doi:10.1097/BSD.0000000000001745

Complications and Cost in Open Versus Endoscopic Lumbar Decompression: A Database Study

Clin Spine Surg. 2025 Jan 6. doi: 10.1097/BSD.0000000000001745. Online ahead of print.

Authors

Lauren M Boden¹, Susanne H Boden², Najib Muhammad¹, Matthew A Kanzler³, David S Casper¹

Affiliations

¹ Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia.
² Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
³ School of Medicine, Yale University, New Haven, CT.

PMID: 39761197
DOI: 10.1097/BSD.0000000000001745

Abstract

Study design: A retrospective database study.

Objective: To compare complications and costs associated with endoscopic and open lumbar decompression on a large scale.

Background: Though open lumbar decompression is considered the gold standard, endoscopic procedures are on the rise. The majority of studies comparing endoscopic to open decompression have been limited to small retrospective studies or studies in other countries.

Methods: Patients who underwent single-level endoscopic or open lumbar decompression from 2017 to 2021 with a 2-year follow-up were identified in the PearlDiver database using Current Procedural Terminology and International Classification of Diseases, Tenth Revision codes. Multilevel surgery, concomitant fusion, or cervical/thoracic procedures were excluded. Postoperative complications, including infection, wound dehiscence, and dural tear, were evaluated for both groups, as well as additional lumbar surgery within 2 years. Costs, complications, and rate of repeat surgery were compared between groups.

Results: A total of 895 endoscopic and 102,258 open lumbar decompression cases met the inclusion criteria. The median age range was 60-64 for both groups, and the majority were low risk on the Charlson Comorbidity Index. Rates of dural tear, infection, and dehiscence were similar between groups. Total cost at 2 years was slightly higher for the endoscopic group ($20,347 vs $18,089, P = 0.03). Patients who underwent endoscopic lumbar decompression were more than twice as likely to undergo a second lumbar surgery in the following 2 years (16% vs 7%, P < 0.00001). Of the patients who underwent additional surgery, there was a higher proportion of patients undergoing reexploration in the open group (33.4% vs 13.8%, P < 0.00001) and a higher proportion undergoing endoscopic decompression in the endoscopic group (35.5% vs 0.64%, P < 0.00001).

Conclusions: Cost and complication profiles are similar between endoscopic and open lumbar decompression. However, endoscopic decompression patients are more than twice as likely to undergo a second procedure within 2 years. Prospective studies are needed to determine the cause of additional surgery.