Objective: Traditional open discectomy has long been the standard treatment for lumbar disc herniation, but minimally invasive endoscopic approaches are increasingly being adopted. However, comprehensive comparative analyses of these techniques in terms of clinical outcomes remain limited. This study aimed to compare the short-term clinical outcomes of endoscopic versus open single-level lumbar discectomy, with the hypothesis that the endoscopic approach reduces postoperative complications within 1 month of surgery. Methods: This retrospective cohort study used data from the MARINER database, covering January 2017 to October 2022. Adult patients aged 18 to 74 years who underwent single-level lumbar discectomy were included. A total of 243,684 patients were identified (1,470 endoscopic and 242,214 open surgical procedures). A 1:3 propensity score matching was performed based on age, sex, Charlson Comorbidity Index, and selected comorbidities, yielding a balanced cohort of 5,640 patients (1,416 endoscopic; 4,224 open). Results: After matching, the demographic and comorbidity profiles of the 2 groups were well balanced. The endoscopic group demonstrated significantly lower rates of surgical site infections (0.35% vs. 0.95%, p<0.05; odds ratio [OR], 2.69; 95% confidence interval [CI], 1.06–6.85), surgical complications (0.71% vs. 1.52%, p<0.05; OR, 2.16; 95% CI, 1.11–4.17), and 30-day readmissions (2.47% vs. 7.65%, p<0.05; OR, 3.09; 95% CI, 2.19–4.36). Kaplan-Meier survival analysis over 18 months revealed no significant difference in the probability of subsequent lumbar fusion between groups (log-rank test p=0.8). Conclusion Endoscopic single-level lumbar discectomy is associated with fewer short-term complications compared with open surgery. These findings support the consideration of endoscopic techniques as a lower-risk alternative for appropriately selected patients. Further studies are needed to evaluate long-term outcomes.

Methods: Data were collected from the American College of Surgeons National Surgical Quality Improvement Program dataset from 2011 to 2018. The cohort was divided into patients with LOS up to 1 day (LOS ≤1 day), defined as same day or next-morning discharge, and patients with LOS >1 day (LOS >1 day). Univariable and multivariable regression analyses were performed to evaluate predictors of LOS >1 day. Propensity-score matching was performed to compare pre- and postdischarge complication rates. Results: A total of 12,664 eligible patients with TLIF were identified, of which 14.8% had LOS ≤1 day and 85.2% had LOS >1 day. LOS >1 day was positively associated with female sex, Hispanic ethnicity, diagnosis of spondylolisthesis, American Society of Anesthesiologists classification 3, and operation length of >150 minutes. Patients with LOS >1 day were more likely to undergo intraoperative/postoperative blood transfusion (0.3% vs. 4.5%, p<0.001) and reoperation (0.1% vs. 0.6%, p=0.004). No significant differences in the rates of postdischarge complications were found between the matched groups. Conclusions Patients with worsened preoperative status, preoperative diagnosis of spondylolisthesis, and prolonged operative time are more likely to require prolonged hospitalization and blood transfusions and undergo unplanned reoperation. To reduce the risk of prolonged hospitalization and associated complications, patients indicated for TLIF should be carefully selected.

Methods: Using an all-payer claims database, patients who underwent elective cervical and lumbar spine interventions between January 1, 2010, and June 30, 2018, were identified. Individuals were categorized into groups taking and not taking antithrombotics. A 1:1 analysis was constructed based on comorbidities found to be independently associated with bleeding or ischemic complications using logistic regression models. The primary outcomes were the rates of thrombo-ischemic events and bleeding complications. Results: A total of 660,866 patients were eligible for inclusion. Following the matching procedure, 56,476 patient records were analyzed, with 28,238 in each group. The antithrombotic agent group had significantly greater odds of developing any 90-day thromboischemic event after surgery: deep vein thrombosis (odds ratio [OR], 3.61; 95% confidence interval [CI], 3.06–4.25), pulmonary embolism (OR, 3.93; 95% CI, 3.34–4.62), myocardial infarction (OR, 6.20; 95% CI, 5.69–6.76), and ischemic stroke (OR, 3.76; 95% CI, 3.31–4.27). In addition, the antithrombotic agent group had an increased likelihood of experiencing hematoma (OR, 1.54; 95% CI, 1.35–1.76) and need for transfusion (OR, 2.61; 95% CI, 2.29–2.96). Conclusions Patients taking antithrombotic medications before elective surgery of the cervical and lumbar spine had increased risks of both ischemic and bleeding events. Spine surgeons should carefully consider these implications when appraising patients for surgery, given the lack of guidelines on perioperative management of antithrombotic agents.

Lumbar spinal stenosis (LSS) is one of the most common affecting the elderly population that may lead to loss of function and the inability to execute basic activities of daily living. While surgical decompression remains the standard of care, choosing an optimal management strategy is usually guided by a set of clinical, radiological, and measurement indices. However, to date, there is a major uncertainty and discrepancy regarding the methodology used. There is also inconsistent adoption of outcome measures across studies, which may result in huge limitations in predicting the efficacy and cost-effectiveness of different treatment paradigms. Herein, we review the various measurement indices used for outcome assessment among patients with LSS, and delineate the major advantages and disadvantages of each index. We call for the development of a single objective outcome measure that encompasses and addresses all issues encountered in this heterogeneous group of patients, including monitoring the patient's progression after treatment.
Activities of Daily Living ; Aged ; Decompression, Surgical ; Humans ; Laminectomy ; Outcome Assessment (Health Care) ; Spinal Stenosis ; Standard of Care ; Uncertainty ; Walking ; Weights and Measures