A Multicenter Prospective Study of Patient Outcomes After Three Full-Endoscopic Lumbar Decompression Techniques.

STUDY

Design

Multicenter prospective observational study.

Objective

To characterize the application and outcome profiles of TELD, IELD, and UBE in routine clinical practice. SUMMARY OF

Background

DATA Full-endoscopic lumbar surgery has been widely used in the treatment of lumbar disc herniation, yet multicenter prospective evidence on patient outcomes in real-world clinical practice remains limited.

Methods

This multicenter prospective real-world study was conducted across 10 medical centers in four regions of China. Perioperative parameters, complications, and patient-reported outcome measures at postoperative day 1 and at 3, 6, and 12 months were recorded. Descriptive group comparisons were supplemented by adjusted repeated-measures analyses accounting for baseline outcome values, clinical covariates, operative level, and center.

Results

A total of 623 patients were included: 105 in the TELD group, 109 in the IELD group, and 409 in the UBE group. Preoperative pain intensity, operative-level distribution, sensory deficit, and center distribution differed among groups. In adjusted analyses, TELD was associated with lower back-pain VAS than UBE at 3 months (mean difference, -0.73; 95% CI, -1.06 to -0.40; Holm P<0.001), 6 months (-0.51; -0.82 to -0.21; P=0.005), and 12 months (-0.77; -0.96 to -0.57; P<0.001). These differences were below the 3-point VAS MCID.

Conclusions

TELD, IELD, and UBE were associated with favorable safety and midterm outcomes in this multicenter cohort. TELD was associated with modestly lower postoperative back-pain scores than UBE after adjustment for measured differences; however, the absolute differences did not reach the prespecified MCID and do not establish causal or universal procedural superiority. LEVEL OF EVIDENCE Level 3.