Clinical Outcomes of Open, Tubular, and Endoscopic Lumbar Discectomy

Study Design: Retrospective cohort study, level III evidence. Objective: Compare demographic characteristics and clinical outcomes among patients undergoing open microdiscectomy (OMD), tubular microdiscectomy (TMD), and full endoscopic discectomy (FED). Summary of Background Data: OMD remains the standard approach for lumbar disc herniation; however, minimally invasive and endoscopic techniques continue to gain popularity. Existing studies typically compare two approaches, with few evaluating all three within a single cohort. Furthermore, data describing outcomes in high-risk patients remains limited. Materials and Methods: Patients above 18 years old undergoing a primary, single-level OMD, TMD, or FED over a 7-year period at a tertiary medical center were included. Continuous variables were analyzed using Kruskal-Wallis tests with Dunn’s post hoc comparisons and categorical variables with χ 2 testing. Multivariate regression and generalized linear models identified predictors of negative outcomes [postoperative complications, revision, or related emergency department visits (EDV) within 1 yr]. Results: In total, 757 patients were included (422 OMD, 190 TMD, 145 FED). FED patients were older (50.1±15.7 yr, P =0.005) with a higher mean body mass index (30.4±6.5 kg/m 2 , P =0.04) and a greater proportion of American Anesthesiology Score (ASA) scores of III (33.9%, P <0.001). FED demonstrated the lowest estimated blood loss (EBL) (7.6 mL, P <0.001), shortest length of stay (LOS) (0.26 d, P <0.001), but with the longest operative time (107.5 min, P <0.001). Complication, revision, and EDV did not differ among the 3 techniques. Multivariate analysis identified the presence of an intraoperative dural tear (RR: 1.29, P =0.007) as predictive of negative outcomes. Conclusion: Endoscopic lumbar discectomies can be safely performed with minimal EBL and LOS; however, surgeries are often longer when compared with TMD and OMD. Lumbar FED is still an emerging technique with a significant learning curve; however, it may expand the availability of surgical procedures to patients who may not have been surgical candidates otherwise.