Endoscopic Single-Level Lumbar Decompression is Performed Faster than Open Decompression: A Study of Operative Times Following 5,098 Consecutive Patients

Introduction: Endoscopic approaches for single-level lumbar decompression, the most commonly performed surgery to treat lumbar radiculopathy, may have potential benefits over a traditional open surgical approach including shorter operative time and faster patient recovery. However, direct quantification and comparison of operative times between endoscopic and open lumbar surgery is still needed.

Methods: All patients who underwent single-level lumbar nerve root decompression between 2019 and 2023 at a multi-hospital academic center with endoscopic and open approaches were identified. Each patient’s demographics, Charlson comorbidity index (CCI), and operative time were collected. Student’s t-tests were used to compare open and endoscopic approaches and assess changes in endoscopic operative time for a newly spine-trained neurosurgeon.

Results: 5098 patients (mean age 58.9 +/- 14.6y) underwent single-level lumbar nerve root decompression with endoscopic only (n=135) or open (n=4962) approaches. Endoscopic cases had significantly lower operative times than open cases (74.6 min vs 81.6 min, p=0.022), with no intergroup differences across gender, BMI, age, and CCI. The 135 endoscopic cases were performed by a single spine surgeon. For 2019-2021 (n=30) the mean endoscopic operative time was 97.5 min (IQR: 47-85 min) while that for 2022-2023 (n=102) was 67.8 min (IQR: 76-113 min), indicating a statistically significant decrease in operative time across this time period by a single surgeon (p=6*10^-6)

Conclusion : To our knowledge, this is the largest comparative study assessing operative time between endoscopic and open lumbar decompression. As we show, endoscopic single-level decompression can be performed faster than open surgery, reducing hospital costs and anesthesia time for each patient. Additionally, familiarity and practice with endoscopic techniques over the course of a surgeon’s career further decreases operative times, illustrating the learning curve of endoscopic surgery and why continual practice rather than solely initial adoption is needed to fully realize the benefits of endoscopic techniques.