Endoscopic versus non-endoscopic decompression for degenerative lumbar spinal stenosis in adults: a systematic review and meta-analysis of randomised trials
- 1Trauma and Orthopaedics Basildon University Hospital
- 2Trauma and Orthopaedics Bedford Hospital
- 3Broomfield Healthcare Library
Abstract
Introduction: Endoscopic decompression may reduce morbidity, but sustained benefits over non-endoscopic surgery remain uncertain. Objective: To assess disability, pain and harms in adult randomised comparisons of decompression without fusion. Methods: MEDLINE, Embase, CINAHL and the Cochrane Library were searched on 23 September 2026. English-language adult randomised trials comparing endoscopic and non-endoscopic decompression without fusion were eligible. Two reviewers independently selected studies and extracted data. Bias and certainty were assessed with the revised Cochrane risk-of-bias tool and the Grading of Recommendations Assessment, Development and Evaluation approach. Compatible estimates used random-effects models with modified Hartung-Knapp intervals. Registration and scope changes were retrospective (Open Science Framework: https://osf.io/qb9a6/). The review received no funding. Results: Sixteen reports described 12 trials allocating 1,212 participants. The protocol-planned 12-month Oswestry Disability Index analysis included four trials (302 participants): mean difference -4.54 points (95% confidence interval -5.95 to -3.13). Zhang F supplied 95.1% of the weight and had reporting concerns. The post hoc sensitivity without that trial included three microscopic comparisons (234 participants): -3.74 (-12.30 to 4.81; low certainty). Six-month disability and exploratory pain analyses were similarly sensitive or uncertain. Nine trials reported 23 durotomies (risk ratio 0.61, 95% confidence interval 0.23 to 1.59; very low certainty). Inconsistent measurement limited blood-loss and reoperation comparisons. Conclusion: Endoscopic decompression has not shown a reliable sustained advantage in disability, pain or safety. The small pooled disability benefit depended heavily on one trial with reporting concerns. Procedure selection should consider the required decompression and surgical expertise; these findings do not establish equivalent safety.
Related
- Comparison of unilateral biportal endoscopic decompression and percutaneous endoscopic lumbar decompression for single-segment degenerative lumbar spinal stenosis: a retrospective comparative study involving clinical efficacy and cost analysis
- Biomechanical comparative analysis of minimally invasive decompression and minimally invasive fusion with internal fixation in the treatment of lumbar spinal stenosis with degenerative spondylolisthesis: a finite element study.
- Coronary artery disease management in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis of randomised controlled trials
- Biportal endoscopic versus minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative disease: a systematic review and meta-analysis.
- Changes in spinopelvic sagittal parameters and functional outcomes after unilateral microscopic decompression for lumbar spinal stenosis
BibTeX
@article{pammi2026endoscopic,
title = {{Endoscopic versus non-endoscopic decompression for degenerative lumbar spinal stenosis in adults: a systematic review and meta-analysis of randomised trials}},
author = {Srinath Pammi and Jithuram Jayaram and Praveen Rajan and Bhargava Krishna Balineni and Maheswara Akula and Kelsey Landes},
journal = {Orthopedic Reviews},
year = {2026},
month = oct,
doi = {10.52965/001c.172721},
url = {https://doi.org/10.52965/001c.172721},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Endoscopic versus non-endoscopic decompression for degenerative lumbar spinal stenosis in adults: a systematic review and meta-analysis of randomised trials
AU - Srinath Pammi
AU - Jithuram Jayaram
AU - Praveen Rajan
AU - Bhargava Krishna Balineni
AU - Maheswara Akula
AU - Kelsey Landes
PY - 2026
DA - 2026/10/26
JO - Orthopedic Reviews
DO - 10.52965/001c.172721
UR - https://doi.org/10.52965/001c.172721
AB - Introduction: Endoscopic decompression may reduce morbidity, but sustained benefits over non-endoscopic surgery remain uncertain. Objective: To assess disability, pain and harms in adult randomised comparisons of decompression without fusion. Methods: MEDLINE, Embase, CINAHL and the Cochrane Library were searched on 23 September 2026. English-language adult randomised trials comparing endoscopic and non-endoscopic decompression without fusion were eligible. Two reviewers independently selected studies and extracted data. Bias and certainty were assessed with the revised Cochrane risk-of-bias tool and the Grading of Recommendations Assessment, Development and Evaluation approach. Compatible estimates used random-effects models with modified Hartung-Knapp intervals. Registration and scope changes were retrospective (Open Science Framework: https://osf.io/qb9a6/). The review received no funding. Results: Sixteen reports described 12 trials allocating 1,212 participants. The protocol-planned 12-month Oswestry Disability Index analysis included four trials (302 participants): mean difference -4.54 points (95% confidence interval -5.95 to -3.13). Zhang F supplied 95.1% of the weight and had reporting concerns. The post hoc sensitivity without that trial included three microscopic comparisons (234 participants): -3.74 (-12.30 to 4.81; low certainty). Six-month disability and exploratory pain analyses were similarly sensitive or uncertain. Nine trials reported 23 durotomies (risk ratio 0.61, 95% confidence interval 0.23 to 1.59; very low certainty). Inconsistent measurement limited blood-loss and reoperation comparisons. Conclusion: Endoscopic decompression has not shown a reliable sustained advantage in disability, pain or safety. The small pooled disability benefit depended heavily on one trial with reporting concerns. Procedure selection should consider the required decompression and surgical expertise; these findings do not establish equivalent safety.
SN - 2035-8237
SN - 2035-8164
ER -