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Objectives and questions: Endoscopic lumbar discectomy is increasingly adopted as a minimally invasive alternative to traditional (i.e.open or tubular) lumbar microdiscectomy. While single-center studies suggest reduced perioperative complications with endoscopic approaches, real-world evidence across broader healthcare systems remains limited. We compared short- and long-term outcomes between endoscopic and traditional lumbar microdiscectomy in a large international database.

Material and methods: We queried the TriNetX Global Collaborative Network (>150 healthcare organizations, ~20 countries) for adults (≥18 years) undergoing traditional lumbar microdiscectomy (CPT 63030; excluding CPT 63035) or endoscopic lumbar discectomy (CPT 62380) between 2005–2023. The index event was the first qualifying procedure. Outcomes were analyzed in three time windows: immediate (day 1), short-term (1–90 days), and long-term (20–730 days). To ensure sufficient follow-up, only patients with index procedures up to August 2023 were included in 2-year analyses. Propensity score matching (1:1) was performed across all available demographic, comorbidity, and laboratory variables. Risk differences, ratios, and odds ratios were calculated; patients were censored at their last recorded fact. Sensitivity analyses including later index dates and excluding patients with pre-existing outcomesyielded similar results.

Results: After matching, 1,987 patients per cohort were analyzed for 90-day outcomes and 1,263 per cohort for 2-year outcomes. At day 1, dural tears were more frequent after open discectomy (1.0% vs. 0.5%, n.s.), while nerve injury was equal (0.5%). At 90 days, wound complications, urinary tract infections, and readmissions were significantly higher after traditional procedures, whereas persistent pain was more common following endoscopic discectomy (6.5% vs. 3.4%, p<0.001). Neurostimulator implantation was also more frequent after open surgery (0.5% vs. 0%, p=0.002). At 2 years, repeat endoscopic procedures were more common after endoscopic discectomy (2.1% vs. 0.8%, p=0.007), while revision open surgery, laminectomy, and posterior fusion rates were comparable.

Discussion and conclusions: In this large real-world cohort, endoscopic discectomy was associated with fewer short-term complications and readmissions compared with traditional microdiscectomy, but also with higher rates of persistent pain and repeat endoscopic procedures at long-term follow-up. These findings complement and partly diverge from single-center reports, highlighting the need for further studies.