Endoscopic, tubular, and open approaches for lumbar radiculopathy: a study of clinical outcomes and operative time following 187 consecutively treated patients

Wednesday, February 21, 2024

Presenting Author(s)

Yohannes Ghenbot, MD

PGY-5 Neurosurgery Resident
University of Pennsylvania
Philadelphia, PA, US

Co-Author(s)

Hasan Ahmad, BS (he/him/his)

Medical Student
University of Pennsylvania
Philadelphia, PA, US
John Arena, MD

Neurosurgery Resident
University of Pennsylvania
Philadelphia, PA, US
Daksh Chauhan, n/a (he/him/his)

Medical Student
University of Pennsylvania
Philadelphia, PA, US
Mert Marcel Dagli, MD (he/him/his)

Neurosurgery Research Fellow
University of Pennsylvania Perelman School of Medicine
Philadelphia, PA, US
DM

Dominick Macaluso, PhD

Data Science Researcher
University of Pennsylvania, United States
AO

Ali Ozturk, MD

Associate Professor
University of Pennsylvania Perelman School of Medicine
Philadelphia, Pennsylvania, United States
Connor Wathen, MD

Resident
University of Pennsylvania
Philadelphia, Pennsylvania, United States
Jang W. Yoon, MD

Professor
University of Pennsylvania Perelman School of Medicine
Philadelphia, PA, US

Introduction: Degenerative lumbar radiculopathy may result from disc disease and facet hypertrophy. Tubular and endoscopic approaches for nerve root decompression have gained popularity as minimally invasive (MIS) techniques. Studies comparing the effectiveness of these approaches are needed to inform surgical decision making and best practices.

Methods: Consecutive patients were identified who underwent lumbar nerve root decompression using endoscopic, tubular, and open approaches. Paired t-tests, chi-square analysis, and linear regression were used to compare patient demographics, surgical time, complications, and patient reported outcome measures (PROMs).

Results: 187 patients (54.8 +/- 16.2 yrs) underwent lumbar nerve root decompression primarily for single-level disc herniation (95.7%) via endoscopic (n = 127), tubular (n = 44), and open (n = 16) approaches. Endoscopic technique had significant improvement in EQ-5D (74.3 vs 58.6, p 0.002), near significant improvement in PROMIS-PF (39.6 vs 36.9, p 0.06), and reduction in PROMIS-PI (59.8 vs 69.8, p < 0.001). Tubular technique had no change in EQ-5D (73.1 vs 75.3, p 0.6) and PROMIS-PF (39.7 vs 36.4, p 0.2), but reduction in PROMIS-PI (60.7 vs 68.8, p 0.003). Open technique had non-significant improvement in EQ-5D (79.8 vs 70.6, p 0.3) and PROMIS-PF (43.6 vs 33.9, 0.1), and significant reduction in PROMIS-PI (57.1 vs 66.3, p 0.04). There was no difference in nerve root injury (p 0.4), durotomy (p 0.4), and reoperation for disc re-herniation (p 0.5). There were no wound infections. Endoscopic technique had the lowest operative time (p = 0.04), linear regression for consecutive endoscopic cases showed a 15-second reduction in operative time per case (operative time = -0.24*case + 98.8, p < 0.001)

Conclusion : Endoscopic, tubular, and open techniques are effective for treating lumbar radiculopathy with similar safety profiles. Endoscopic techniques may improve OR utilization through reduced procedure time.