Endoscopic Versus Open Lumbar Decompression: A Propensity-Matched National Cohort Study of 50,000 Patients with 90-Day Follow-Up

Endoscopic Versus Open Lumbar Decompression: A Propensity-Matched National Cohort Study of 50,000 Patients with 90-Day Follow-Up | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Endoscopic Versus Open Lumbar Decompression: A Propensity-Matched National Cohort Study of 50,000 Patients with 90-Day Follow-Up Dana Hazem, Rohit Srinivas, Harlene Kaur, Rahul Kumar, Rohan Phadke, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8244767/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 21 Feb, 2026 Read the published version in Neurosurgical Review → Version 1 posted 10 You are reading this latest preprint version Abstract Introduction: Endoscopic lumbar decompression has emerged as a minimally invasive alternative to open decompression for degenerative lumbar disease. Although prior work suggests potential recovery benefits, large-scale data comparing safety outcomes remain limited. This study compared 90-day complications, reoperation, and healthcare utilization between endoscopic and open lumbar decompression using a national database. Methods We performed a retrospective cohort study using the TriNetX U.S. Research Network. Adults undergoing lumbar decompression were identified using procedure codes for percutaneous endoscopic decompression or discectomy versus conventional open decompression. Primary outcomes were incidental durotomy, cerebrospinal fluid (CSF) leak or pseudomeningocele, and unplanned reoperation. Secondary outcomes included emergency department revisit, readmission, length of stay, discharge disposition, meningitis, wound disruption, venous thromboembolism, and myocardial infarction. Propensity score matching was performed 1:1 using demographic and clinical covariates. Results After matching, 25,242 patients were included in each cohort. Endoscopic decompression demonstrated lower rates of incidental durotomy (0.3% vs 0.5%), CSF leak or pseudomeningocele (0.2% vs 0.5%), and unplanned reoperation (0.1% vs 1.8%). Healthcare utilization (7.2% vs 6.8%) and meningitis (0.4% vs 0.3%) were slightly higher in the endoscopic cohort. No significant differences were seen in wound disruption, venous thromboembolism, or myocardial infarction. Conclusion Endoscopic lumbar decompression was associated with lower 90-day rates of select complications and reoperation, though absolute differences were small. Slightly higher utilization and meningitis rates were observed, but systemic complication rates were comparable. Overall, endoscopic decompression appears safe with modest advantages over open surgery. Level of Evidence Level III Retrospective Comparative Cohort Study Endoscopic spine surgery lumbar decompression degenerative spine disease perioperative complications surgical outcomes Introduction Degenerative lumbar disease represents a prevalent and disabling condition, frequently necessitating surgical intervention when conservative treatments prove insufficient. Lumbar decompression, a foundational procedure, aims to alleviate neural compression and mitigate associated symptoms such as radiculopathy and neurogenic claudication. Historically, conventional open decompression served as the standard surgical approach. However, advancements in surgical techniques have introduced minimally invasive alternatives, with endoscopic lumbar decompression emerging as a promising option [1]. Initial studies suggest that minimally invasive techniques may offer benefits such as reduced perioperative morbidity, decreased blood loss, and potentially faster recovery times [2–3]. Despite a growing body of literature, large-scale comparative evidence on the comprehensive safety profiles, including complication rates and healthcare utilization, between endoscopic and conventional open approaches for lumbar decompression, remains a critical gap in the existing research landscape to help guide patient selection and healthcare policy decisions. Conventional open lumbar decompression involves a larger incision, requiring greater dissection of paraspinal musculature to expose the spinal elements. This traditional method, while effective in achieving neural decompression, is often associated with more extensive soft tissue trauma [4]. In contrast, endoscopic lumbar decompression utilizes small incisions and specialized endoscopes, allowing for direct visualization and targeted removal of compressive structures with minimal disruption to surrounding tissues [1]. This approach, often referred to as an "ultra-minimally invasive" technique, seeks to preserve spinal stability while achieving adequate decompression [3–4]. Both techniques share the fundamental objective of relieving pressure on neural elements, thereby improving patient symptoms and functional status. Surgical interventions for degenerative lumbar disease are inherently associated with various perioperative risks. Perioperative complications such as incidental durotomy, cerebrospinal fluid (CSF) leak, infection, and the need for unplanned reoperation are well-documented across spinal procedures [5–6]. While minimally invasive techniques are often praised for reducing certain risks, their specific safety profiles in comparison to open surgery, particularly regarding less common but significant events like meningitis or systemic complications such as myocardial infarction and venous thromboembolism, require further investigation. Therefore, understanding the differential rates of these complications is essential for informing surgical practice and patient counseling. The primary objective of this investigation was to conduct a comprehensive comparison of 90-day complication rates, unplanned reoperation rates, and patterns of healthcare utilization between endoscopic and conventional open lumbar decompression. This study leveraged TrinetX Research Network, a large deidentified national database, and employed propensity score matching to mitigate selection bias, thereby offering a robust comparative analysis. By examining these critical outcomes, this research aimed to provide valuable insights for clinicians, patients, and healthcare policymakers regarding the relative safety and early-term post-operative course associated with each surgical modality. The findings contribute to an evidence-based understanding of these increasingly utilized surgical approaches. Materials and Methods A retrospective cohort study was conducted utilizing the TriNetX Research Network. This platform aggregates de-identified electronic health records from 105 U.S. healthcare organizations, encompassing a diverse patient population. As this study involved analysis of de-identified data and did not include any procedures performed on humans or animals beyond routine clinical care, no human or animal subjects were directly involved, and institutional review board approval and informed consent were not required. Adult patients who underwent lumbar decompression were identified through specific procedure codes. The endoscopic cohort included individuals with codes (see appendix) for percutaneous endoscopic lumbar decompression and discectomy. The non-endoscopic cohort comprised patients undergoing conventional open decompression. The TriNetX platform's 20-year look-back period for index events ensured comprehensive patient history; no patients were excluded based on this criterion. Patients presenting with concurrent conditions such as fracture, infection, tumor, deformity, or those with alternative decompression codes were systematically excluded from both cohorts to ensure a focused comparison of degenerative lumbar disease. Propensity score matching was then performed at a 1:1 ratio. This methodology balanced baseline characteristics between the endoscopic and open decompression groups. Matching covariates included patient age, sex, race/ethnicity, pre-existing comorbidities, and the specific surgical indication for decompression. Outcomes were assessed for a 90-day period following the index procedure, starting from day 1. Primary outcomes of interest included incidental durotomy, CSF leak or pseudomeningocele formation, and the occurrence of unplanned reoperation. Secondary outcomes comprised emergency department revisits, inpatient readmissions, length of hospital stay, discharge disposition, meningitis, wound disruption, venous thromboembolism, and myocardial infarction. Superficial and deep surgical site infections were not amenable due to low (< 10) count to analysis due to limitations in data export. All statistics were run in Trinetx and Excel. Measures of association between the matched cohorts were reported as risk ratios (RR) along with their corresponding 95% confidence intervals (CI). Statistical significance for all comparisons was established at a p-value threshold of less than 0.05. Results 33,324 patients were found for the endoscopic group and 181,116 for the non-endoscopic group prior to matching. Following a rigorous propensity score matching process, the study cohorts each consisted of 25,242 patients. This matching is shown in Tables 1 & 2 and ensured that baseline characteristics, including age, sex, race/ethnicity, comorbidities, and surgical indication, were comparable between the endoscopic and open decompression groups, thereby minimizing confounding biases. Table 1 Patient characteristics prior to matching Variable Endoscopic (n = 33,324) Non-endoscopic (n = 178,637) P-value Std diff Age at Index (mean ± SD) 55.5 ± 15.5 56.3 ± 16.2 < 0.001 0.047 Female, n (%) 12,406 (43.4%) 67,429 (39.3%) < 0.001 0.084 Male, n (%) 16,100 (56.4%) 96,680 (56.4%) 0.960 < 0.001 White, n (%) 17,553 (61.5%) 132,854 (77.5%) < 0.001 0.353 Black or African American, n (%) 1,722 (6.0%) 11,339 (6.6%) < 0.001 0.024 Hispanic or Latino, n (%) 924 (3.2%) 9,643 (5.6%) < 0.001 0.116 Asian, n (%) 5,926 (20.8%) 4,246 (2.5%) < 0.001 0.595 Unknown Race, n (%) 2,252 (7.9%) 17,600 (10.3%) < 0.001 0.083 Other Race, n (%) 556 (1.9%) 4,375 (2.6%) < 0.001 0.041 Hypertension, n (%) 9,291 (32.5%) 68,066 (39.7%) < 0.001 0.150 Diabetes mellitus, n (%) 3,995 (14.0%) 28,442 (16.6%) < 0.001 0.072 Hyperlipidemia, n (%) 4,990 (17.5%) 45,656 (26.6%) < 0.001 0.222 Overweight/Obesity, n (%) 2,198 (7.7%) 32,622 (19.0%) < 0.001 0.338 Tobacco use, n (%) 212 (0.7%) 5,837 (3.4%) < 0.001 0.188 Alcohol use, n (%) 45 (0.2%) 1,408 (0.8%) < 0.001 0.095 Opioid-related disorders, n (%) 239 (0.8%) 2,890 (1.7%) < 0.001 0.076 Cannabis-related disorders, n (%) 148 (0.5%) 2,471 (1.4%) < 0.001 0.094 Sedative/anxiolytic disorders, n (%) 29 (0.1%) 442 (0.3%) < 0.001 0.037 Cocaine-related disorders, n (%) 117 (0.4%) 911 (0.5%) 0.008 0.018 Other stimulant disorders, n (%) 45 (0.2%) 480 (0.3%) < 0.001 0.026 Hallucinogen disorders, n (%) 10 (0.0%) 80 (0.0%) 0.390 0.006 Nicotine dependence, n (%) 2,303 (8.1%) 22,448 (13.1%) < 0.001 0.164 Inhalant disorders, n (%) 141 (0.5%) 778 (0.5%) 0.356 0.006 Other psychoactive disorders, n (%) 260 (0.9%) 2,009 (1.2%) < 0.001 0.026 CKD, n (%) 1,043 (3.7%) 9,279 (5.4%) < 0.001 0.085 COPD, n (%) 1,129 (4.0%) 8,899 (5.2%) < 0.001 0.059 Heart failure, n (%) 608 (2.1%) 6,126 (3.6%) < 0.001 0.087 Acute myocardial infarction, n (%) 461 (1.6%) 4,212 (2.5%) < 0.001 0.060 Cerebral infarction, n (%) 479 (1.7%) 3,618 (2.1%) < 0.001 0.032 TIA, n (%) 512 (1.8%) 3,413 (2.0%) 0.026 0.015 Spinal stenosis (lumbar), n (%) 10,484 (36.7%) 95,609 (55.8%) < 0.001 0.389 Stenosis without claudication, n (%) 2,928 (10.3%) 55,599 (32.4%) < 0.001 0.562 Disc displacement lumbar, n (%) 11,211 (39.3%) 81,273 (47.4%) < 0.001 0.165 Disc displacement lumbosacral, n (%) 7,315 (25.6%) 46,904 (27.4%) < 0.001 0.040 Radiculopathy lumbar, n (%) 6,375 (22.3%) 90,825 (53.0%) < 0.001 0.667 Radiculopathy lumbosacral, n (%) 5,230 (18.3%) 47,243 (27.6%) < 0.001 0.221 Table 2 Patient characteristics after matching Variable Endoscopic (n = 33,324) Non-endoscopic (n = 178,637) P-value Std diff Age at Index (mean ± SD) 55.2 ± 15.4 55.0 ± 15.7 0.075 0.016 Female, n (%) 10,922 (43.3%) 10,894 (43.2%) 0.801 0.002 Male, n (%) 14,269 (56.5%) 14,285 (56.6%) 0.886 0.001 White, n (%) 17,552 (69.5%) 17,996 (71.3%) < 0.001 0.039 Black or African American, n (%) 1,721 (6.8%) 1,575 (6.2%) 0.009 0.023 Hispanic or Latino, n (%) 921 (3.6%) 825 (3.3%) 0.019 0.021 Asian, n (%) 2,726 (10.8%) 2,685 (10.6%) 0.555 0.005 Unknown Race, n (%) 2,252 (8.9%) 2,065 (8.2%) 0.003 0.026 Other Race, n (%) 555 (2.2%) 520 (2.1%) 0.281 0.010 Hypertension, n (%) 8,100 (32.1%) 7,736 (30.6%) < 0.001 0.031 Diabetes mellitus, n (%) 3,349 (13.3%) 2,951 (11.7%) < 0.001 0.048 Hyperlipidemia, n (%) 4,536 (18.0%) 4,373 (17.3%) 0.057 0.017 Overweight/Obesity, n (%) 2,160 (8.6%) 2,013 (8.0%) 0.018 0.021 Tobacco use, n (%) 212 (0.8%) 206 (0.8%) 0.768 0.003 Alcohol use, n (%) 45 (0.2%) 36 (0.1%) 0.317 0.009 Opioid-related disorders, n (%) 236 (0.9%) 172 (0.7%) 0.001 0.028 Cannabis-related disorders, n (%) 148 (0.6%) 108 (0.4%) 0.012 0.022 Sedative/anxiolytic disorders, n (%) 29 (0.1%) 19 (0.1%) 0.149 0.013 Cocaine-related disorders, n (%) 114 (0.5%) 79 (0.3%) 0.012 0.022 Other stimulant disorders, n (%) 42 (0.2%) 32 (0.1%) 0.245 0.010 Hallucinogen disorders, n (%) 10 (0.0%) 10 (0.0%) 1 < 0.001 Nicotine dependence, n (%) 2,263 (9.0%) 2,086 (8.3%) 0.005 0.025 Inhalant disorders, n (%) 137 (0.5%) 83 (0.3%) < 0.001 0.032 Other psychoactive disorders, n (%) 248 (1.0%) 177 (0.7%) 0.001 0.031 CKD, n (%) 809 (3.2%) 673 (2.7%) < 0.001 0.032 COPD, n (%) 1,002 (4.0%) 791 (3.1%) < 0.001 0.045 Heart failure, n (%) 542 (2.1%) 423 (1.7%) < 0.001 0.034 Acute myocardial infarction, n (%) 437 (1.7%) 347 (1.4%) 0.001 0.029 Cerebral infarction, n (%) 400 (1.6%) 346 (1.4%) 0.046 0.018 TIA, n (%) 396 (1.6%) 303 (1.2%) < 0.001 0.032 Spinal stenosis (lumbar), n (%) 9,090 (36.0%) 8,846 (35.0%) 0.023 0.020 Spinal stenosis without claudication, n (%) 2,928 (11.6%) 2,910 (11.5%) 0.802 0.002 Disc displacement lumbar, n (%) 9,563 (37.9%) 9,219 (36.5%) 0.002 0.028 Disc displacement lumbosacral, n (%) 6,469 (25.6%) 6,344 (25.1%) 0.201 0.011 Radiculopathy lumbar, n (%) 6,350 (25.2%) 6,499 (25.7%) 0.128 0.014 Radiculopathy lumbosacral, n (%) 5,200 (20.6%) 5,533 (21.9%) < 0.001 0.032 Endoscopic decompression demonstrated statistically lower rates for several primary complications compared to open decompression. Incidental durotomy occurred in 0.3% of the endoscopic cohort versus 0.5% in the open cohort (RR 0.55, p < 0.001). Similarly, CSF leak or pseudomeningocele formation was observed in 0.2% of endoscopic cases versus 0.5% of open cases (RR 0.45, p < 0.001). Unplanned reoperation rates were also significantly lower in the endoscopic group, at 0.1% compared to 1.8% in the open group (RR 0.06, p < 0.001). Analysis of secondary outcomes revealed mixed results. Healthcare utilization was marginally higher in the endoscopic decompression cohort (7.2% vs 6.8%, RR 1.07, p = 0.041). Meningitis also occurred more frequently among patients undergoing endoscopic decompression (0.4% vs 0.3%, RR 1.44, p = 0.018). Conversely, no statistically significant differences were detected between the groups for wound disruption (0.7% vs 0.8%, p = 0.269), deep vein thrombosis (0.8% vs 0.7%, p = 0.193), or myocardial infarction (0.4% vs 0.2%, p = 0.356). Overall, endoscopic decompression was associated with significantly lower rates of major surgical complications, though it demonstrated slightly higher rates of postoperative healthcare utilization and meningitis. Table 3 90-day primary and secondary outcomes of endoscopic and open decompression groups Outcome Endoscopic (n/N, %) Non-endoscopic or open (n/N, %) Risk Difference (95% CI) Risk Ratio (95% CI) Odds Ratio (95% CI) P-value Incidental durotomy 74 / 25,242 (0.3%) 135 / 25,242 (0.5%) -0.002 (-0.004, -0.001) 0.548 (0.413, 0.727) 0.547 (0.412, 0.726) < 0.001 CSF leak / pseudomeningocele 59 / 25,242 (0.2%) 130 / 25,242 (0.5%) -0.003 (-0.004, -0.002) 0.454 (0.334, 0.617) 0.453 (0.333, 0.616) < 0.001 Unplanned reoperation 25 / 25,242 (0.1%) 451 / 25,242 (1.8%) -0.017 (-0.019, -0.015) 0.055 (0.037, 0.083) 0.054 (0.036, 0.082) < 0.001 Healthcare utilization (ED/IP) 1,826 / 25,242 (7.2%) 1,709 / 25,242 (6.8%) 0.005 (0.000, 0.009) 1.068 (1.003, 1.139) 1.074 (1.003, 1.150) 0.041 Meningitis 102 / 25,242 (0.4%) 71 / 25,242 (0.3%) 0.001 (0.000, 0.002) 1.437 (1.062, 1.944) 1.438 (1.062, 1.948) 0.018 Wound disruption/dehiscence 171 / 25,242 (0.7%) 192 / 25,242 (0.8%) -0.001 (-0.002, 0.001) 0.891 (0.725, 1.094) 0.890 (0.724, 1.094) 0.269 Deep vein thrombosis (LE) 198 / 25,242 (0.8%) 173 / 25,242 (0.7%) 0.001 (-0.000, 0.002) 1.145 (0.934, 1.402) 1.146 (0.934, 1.406) 0.193 Myocardial infarction 104 / 25,242 (0.4%) 62 / 25,242 (0.3%) 0.0017 (0.001, 0.003) 1.677 (1.225, 2.296) 1.680 (1.226, 2.302) 0.356 Discussion The present large-scale, propensity-matched cohort study indicates that endoscopic lumbar decompression is associated with statistically lower rates of incidental durotomy and CSF leak or pseudomeningocele formation compared to conventional open decompression. Specifically, the incidence of incidental durotomy was nearly halved in the endoscopic group (0.3% vs. 0.5%, RR 0.55), and CSF leak or pseudomeningocele was less than half (0.2% vs. 0.5%, RR 0.45). This statistical difference aligns with the theoretical advantages of minimally invasive techniques, which aim to reduce tissue disruption and enhance visualization of delicate neural structures [1]. However, the absolute differences, though statistically significant, are notably small. A reduction from 0.5% to 0.3% for incidental durotomy, for instance, represents a very modest clinical impact on an individual patient's risk profile. While existing literature reports incidental durotomy rates ranging from 0.5% to 18% in open surgery and 1.7% to 4.3% in endoscopic procedures, the rates observed in this study for both techniques are at the lower end of these ranges, suggesting overall improvements in surgical safety or differences in reporting mechanisms [6]. A particularly striking finding was the significantly lower rate of unplanned reoperation in the endoscopic cohort (0.1% vs. 1.8%, RR 0.06). This almost 18-fold reduction in reoperation risk, even with small absolute percentages, represents a substantial comparative advantage for endoscopic decompression. Unplanned reoperation is a critical patient safety and healthcare utilization metric. Pseudomeningocele formation, often a sequela of incidental durotomy, was also significantly lower in the endoscopic group. The ability of endoscopic techniques to achieve adequate decompression while potentially minimizing trauma to surrounding structures, including the dura, may contribute to these reduced rates [4]. Lower reoperation rates translate into fewer patient morbidities, improved long-term outcomes, and reduced healthcare burden. This specific finding merits further investigation into the underlying mechanisms that confer such a protective effect in the endoscopic group within a 90-day window. In contrast to the favorable primary outcomes, the endoscopic group exhibited a slightly higher rate of meningitis (0.4% vs. 0.3%, RR 1.44) and overall healthcare utilization (7.2% vs. 6.8%, RR 1.07). The increased incidence of meningitis in endoscopic procedures, while statistically significant, is based on very low absolute numbers. The precise reasons for this observation warrant deeper investigation. Endoscopic procedures involve continuous irrigation, which, if not meticulously controlled, could theoretically introduce contaminants or lead to fluid extravasation, though typically these are sterile environments. Alternatively, this may reflect differing patient characteristics or post-operative management protocols that were not fully captured by the propensity matching. The marginally higher healthcare utilization in the endoscopic cohort challenges the common perception that minimally invasive surgery invariably leads to lower post-operative resource consumption. While minimally invasive procedures are often associated with shorter hospital stays [7], increased emergency department revisits or outpatient follow-ups for specific complications could collectively contribute to a higher overall utilization rate [8]. The present study did not observe increases in systemic complications such as wound disruption, deep vein thrombosis, or myocardial infarction in the endoscopic cohort, which provides reassurance regarding the systemic safety profile of these procedures. The findings of this national cohort study present a nuanced perspective when compared to existing literature. Several meta-analyses and systematic reviews have previously supported the notion that full-endoscopic spinal decompression offers advantages over microscopic decompression, including better leg pain improvement, shorter operative times, and fewer complications [9]. Similarly, some studies comparing endoscopic techniques to other minimally invasive approaches have shown benefits such as shorter hospital stays and improved pain scores for endoscopic patients, despite potentially longer operative times [7]. However, other research has presented more equivocal results. A multicenter comparison using a national database, albeit with a much smaller endoscopic cohort (34 patients), found that endoscopically guided approaches did not significantly reduce adverse events, length of stay, or operative time compared to open techniques [10]. Another retrospective analysis indicated that minimally invasive techniques did not result in increased reoperation or 30- and 90-day readmission rates when compared to open approaches, suggesting similar safety profiles for some metrics [11]. The current study, with its exceptionally large, propensity-matched national cohort, offers a robust dataset that helps clarify some of these previously conflicting observations. Taken together, the demonstration of statistically lower primary complication rates for endoscopic surgery, even with small absolute differences, generally aligns with the trend favoring less invasive approaches in reducing direct surgical morbidity. The most significant clinical implication from this study lies in the magnitude of the observed differences. While the statistically significant reductions in incidental durotomy and CSF leak/pseudomeningocele rates are noteworthy, their absolute differences are small. For instance, a 0.2% absolute reduction in incidental durotomy may not translate into a perceived substantial benefit for the average patient or surgeon when considering surgical choice. This contrasts with the more pronounced reductions in hospital length of stay and faster recovery often attributed to minimally invasive techniques in other studies [2]. However, the considerable reduction in unplanned reoperation (from 1.8% to 0.1%) represents a clinically meaningful difference. While still a small absolute percentage, avoiding reoperation has substantial benefits for patient morbidity, recovery trajectory, and overall healthcare costs. The slightly increased rates of meningitis and healthcare utilization in the endoscopic group, though statistically significant, are also of small absolute magnitude. Overall, these results support the safety of endoscopic decompression but indicate its benefits are incremental rather than transformative. Clinical decision-making should therefore balance these subtle differences with other factors, such as patient-specific characteristics, surgeon expertise, and the potential for perceived benefits like smaller incisions and quicker initial recovery, which were not directly measured in this study's outcomes. This study possesses several notable strengths. Its foundation in a large, national, de-identified electronic health records network (TriNetX Research Network) provides a real-world perspective on outcomes, encompassing a vast and diverse patient population of 50,000 individuals. The use of propensity score matching to balance baseline characteristics between the endoscopic and open decompression cohorts significantly reduces the risk of selection bias, thereby enhancing the internal validity of the comparative analysis. Furthermore, the 90-day follow-up period allows for capture of early but critical postoperative complications and healthcare utilization patterns. Despite these strengths, certain limitations warrant consideration. The retrospective nature of the study, inherent to database analyses, means that unmeasured confounding variables might exist, even after propensity matching. The reliance on administrative codes for identifying diagnoses and procedures, while robust in a large dataset, can introduce inaccuracies or miss nuances in clinical presentation or surgical technique. For instance, previous research indicates that International Classification of Diseases (ICD) codes for incidental durotomy have limited sensitivity, potentially leading to underreporting of this specific complication [6]. The study also lacked granular data on functional outcomes, such as Visual Analog Scale (VAS) scores or Oswestry Disability Index (ODI), which are crucial for assessing the patient's perspective on surgical success. The inability to analyze superficial and deep surgical site infections due to data export limitations represents another gap in the comprehensive safety profile. Finally, the 90-day follow-up captures early outcomes but does not provide information on long-term complication rates, reoperation beyond 90 days, or sustained functional improvement. The findings from this large national cohort study offer valuable data points for clinicians navigating the choice between endoscopic and open lumbar decompression. The statistically lower rates of incidental durotomy, cerebrospinal fluid leak, and unplanned reoperation associated with endoscopic approaches provide some objective support for its safety profile. However, the small absolute differences in these primary outcomes should be interpreted in context of their small absolute effect sizes. For example, while the relative risk reduction for incidental durotomy is considerable, the absolute difference of 0.2% may not be the sole determinant for surgical selection in many cases. Conversely, the statistically higher rates of meningitis and overall healthcare utilization in the endoscopic group, while also small in absolute terms, warrant careful consideration. These findings underscore that while endoscopic techniques offer advantages, they are not without their own distinct, albeit rare, risks and resource implications. Clinicians should integrate these data with individual patient characteristics, including comorbidities, anatomical considerations, and personal preferences. Furthermore, surgeon experience and the learning curve associated with endoscopic techniques are critical factors [12]. For instance, preventing incidental dural tears during the early learning period requires meticulous technique and clear visualization [5]. Ultimately, the decision should be individualized, balancing the modest observed benefits in certain complications against the slight increase in others, alongside other clinical factors and patient expectations. In summary, endoscopic decompression offers a modest but measurable safety advantage over open surgery, supporting its continued adoption while underscoring the need for careful patient selection and technical expertise. Conclusion This large, propensity-matched national cohort study compared safety outcomes and early healthcare utilization between endoscopic and open lumbar decompression in over 50,000 patients. Endoscopic decompression was associated with significantly fewer primary surgical complications than open decompression, including statistically lower rates of incidental durotomy, cerebrospinal fluid leak, and unplanned reoperation. Specifically, incidental durotomy occurred in 0.3% of endoscopic cases versus 0.5% of open cases, and CSF leak or pseudomeningocele in 0.2% versus 0.5%. The rate of unplanned reoperation was markedly lower in the endoscopic group at 0.1% compared to 1.8% in the open cohort. However, it is crucial to note that the absolute differences for incidental durotomy and CSF leak were small, suggesting a modest clinical impact for these specific outcomes. These differences, while small in absolute terms, suggest a trend toward improved perioperative safety with endoscopic techniques. Conversely, endoscopic cases exhibited slightly higher rates of overall healthcare utilization (7.2% vs. 6.8%) and meningitis (0.4% vs. 0.3%). No significant differences were observed in systemic complications such as wound disruption, deep vein thrombosis, or myocardial infarction. Overall, these findings affirm the general safety of endoscopic approaches for lumbar decompression, though their early-term advantages over open decompression, though the magnitude of difference was modest.. Beyond the immediate findings, the results of this study offer important implications for both clinical practice and future research endeavors. For clinicians, the data support the safety profile of endoscopic lumbar decompression, indicating that it can be considered a viable alternative to conventional open surgery with a potentially lower risk of reoperation within the early postoperative period. However, the modest absolute differences in some complication rates suggest that patient selection, surgeon expertise, and a balanced discussion of risks and benefits remain paramount in clinical decision-making. For future research, several avenues emerge. Studies with longer-term follow-up are essential to ascertain if the observed early differences in reoperation rates are sustained and how they influence long-term functional outcomes, patient satisfaction, and recurrence rates. Incorporating patient-reported outcome measures (PROMs) such as VAS and ODI would provide a more holistic understanding of surgical efficacy from the patient's perspective. Further investigations should also explore the factors contributing to the slightly elevated meningitis and healthcare utilization rates in the endoscopic group, potentially through more granular data on post-operative management or specific endoscopic techniques. Comparative cost-effectiveness analyses, factoring in both direct surgical costs and downstream healthcare utilization, would also contribute significantly to the literature. In summary, endoscopic lumbar decompression offers a modest but measurable safety advantage over open surgery, supporting its use as a viable minimally invasive alternative pending further long-term validation. Declarations Conflicts of Interest : The authors declare no conflicts of interest Consent to Participate: This study used de-identified, retrospective data from a national database. Thus, individual consent to participate was not required in accordance with institutional and database use policies. Clinical trial number not applicable. Ethics Approval/Exemption Not applicable Guideline Adherence to STROBE Funding: No funding was involved in this study. Author Contribution Dana Hazem and Rohit Srinivas conceived and supervised the study design and manuscript drafting and revisions; Harlene Kaur, Rahul Kumar, and Rohan Phadke performed data extraction, statistical analysis, and manuscript drafting and revision; Swapna Vaja assisted with manuscript drafting and revisions; Nathan J. Lee contributed to study design and manuscript revision. All authors reviewed and approved the final manuscript. Acknowledgments: None Data Availability This study used de‑identified patient‑level data licensed from the TriNetX research network (TriNetX Real‑World Dataset; third‑party, de‑identified electronic health record data). The dataset is not publicly available due to contractual and privacy restrictions, but access to similar datasets can be requested directly from TriNetX (https://trinetx.com), and analytic code and aggregated outputs supporting the findings are available from the corresponding author upon reasonable request, subject to TriNetX licensing conditions. References Pholprajug, P., Kotheeranurak, V., Liu, Y., & Kim, J.-S. (2023). The Endoscopic Lumbar Interbody Fusion: A Narrative Review, and Future Perspective. Neurospine, 20(4), 1224–1245. https://doi.org/10.14245/ns.2346888.444 Guo, H., Song, Y., Weng, R., Tian, H., Yuan, J., & Li, Y. (2022). Comparison of Clinical Outcomes and Complications Between Endoscopic and Minimally Invasive Transforaminal Lumbar Interbody Fusion for Lumbar Degenerative Diseases: A Systematic Review and Meta-analysis. Global Spine Journal, 13(5), 1394–1404. https://doi.org/10.1177/21925682221142545 Kamson, S. (2017). Full-Endoscopic Assisted Lumbar Decompressive Surgery Performed in an Outpatient, Ambulatory Facility: Report of 5 Years of Complications and Risk Factors. Pain Physician, 20(2), E221–E231. https://doi.org/10.36076/ppj.2017.e231 Kim, J.-E., & Choi, D.-J. (2018). Clinical and Radiological Outcomes of Unilateral Biportal Endoscopic Decompression by 30° Arthroscopy in Lumbar Spinal Stenosis: Minimum 2-Year Follow-up. Clinics in Orthopedic Surgery, 10(3), 328. https://doi.org/10.4055/cios.2018.10.3.328 Kim, H.-S., Wu, P. H., & Jang, I.-T. (2020). Lumbar Endoscopic Unilateral Laminotomy for Bilateral Decompression Outside-In Approach: A Proctorship Guideline With 12 Steps of Effectiveness and Safety. Neurospine, 17(Suppl 1), S99–S109. https://doi.org/10.14245/ns.2040078.039 Toci, G., Lambrechts, M. J., Issa, T., Karamian, B., Siegel, N., Antonio, N. D., Canseco, J., Kurd, M., Woods, B., Kaye, I. D., Hilibrand, A., Kepler, C., Vaccaro, A., & Schroeder, G. (2023). Incidence, Risk Factors, and Outcomes of Incidental Durotomy during Lumbar Spine Decompression with or without Fusion. Asian Spine Journal, 17(4), 647–655. https://doi.org/10.31616/asj.2022.0297 McGrath, L. B., White-Dzuro, G. A., & Hofstetter, C. P. (2019). Comparison of clinical outcomes following minimally invasive or lumbar endoscopic unilateral laminotomy for bilateral decompression. Journal of Neurosurgery: Spine, 30(4), 491–499. https://doi.org/10.3171/2018.9.spine18689 Leyendecker, J., Prasse, T., Park, C., Köster, M., Rumswinkel, L., Shenker, T., Bieler, E., Eysel, P., Bredow, J., Zaki, M. M., Kathawate, V., Harake, E., Joshi, R. S., Konakondla, S., Kashlan, O. N., Derman, P., Telfeian, A., & Hofstetter, C. P. (2024). 90-Day Emergency Department Utilization and Readmission Rate After Full-Endoscopic Spine Surgery: A Multicenter, Retrospective Analysis of 821 Patients. Neurosurgery, 96(2), 318–327. https://doi.org/10.1227/neu.0000000000003095 Yang, Z., Wang, H., Li, W., & Hu, W. (2022). Comparative Effects and Safety of Full-Endoscopic Versus Microscopic Spinal Decompression for Lumbar Spinal Stenosis: A Meta-Analysis and Statistical Power Analysis of 6 Randomized Controlled Trials. Neurospine, 19(4), 996–1005. https://doi.org/10.14245/ns.2244600.300 Chiu, R. G., Patel, S., Zhu, A., Aguilar, E., & Mehta, A. I. (2019). Endoscopic Versus Open Laminectomy for Lumbar Spinal Stenosis: An International, Multi-Institutional Analysis of Outcomes and Adverse Events. Global Spine Journal, 10(6), 720–728. https://doi.org/10.1177/2192568219872157 Altshuler, M., Mueller, K. B., MacConnell, A., Wirth, P., Sandhu, F. A., & Voyadzis, J.-M. (2020). Reoperation, Readmission, and Discharge Disposition for Patients With Degenerative Lumbar Pathology Treated With Either Open or Minimally Invasive Techniques: A Single-Center Retrospective Review of 1435 Cases. Neurosurgery, 87(6), 1199–1205. https://doi.org/10.1093/neuros/nyaa246 Liounakos, J. I., & Wang, M. Y. (2020). The Endoscopic Approach to Lumbar Discectomy, Fusion, and Enhanced Recovery: A Review. Global Spine Journal, 10(2_suppl), 65S–69S. https://doi.org/10.1177/2192568219884913 Additional Declarations No competing interests reported. Supplementary Files FinalSupplementaryAppendixEndoscopic1.docx Cite Share Download PDF Status: Published Journal Publication published 21 Feb, 2026 Read the published version in Neurosurgical Review → Version 1 posted Editorial decision: Revision requested 04 Jan, 2026 Reviewers agreed at journal 16 Dec, 2025 Reviews received at journal 15 Dec, 2025 Reviewers agreed at journal 15 Dec, 2025 Reviews received at journal 15 Dec, 2025 Reviewers agreed at journal 15 Dec, 2025 Reviewers invited by journal 15 Dec, 2025 Editor assigned by journal 07 Dec, 2025 Submission checks completed at journal 03 Dec, 2025 First submitted to journal 30 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Chan School of Medicine, UMass Chan Medical School","correspondingAuthor":false,"prefix":"","firstName":"Harlene","middleName":"","lastName":"Kaur","suffix":""},{"id":561909989,"identity":"bce0bce1-5f8f-48eb-a633-9207f4a22621","order_by":3,"name":"Rahul Kumar","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/klEQVRIiWNgGAWjYFACHgaGBwwJIBb7hw9IgowN+LQkQLSwMc4gWQszDzFazNvPHpNIYEhLXNt+9tlj27Zt8vL9pxMfvGGwkd1wALsWmTN5aUAtOYnbzqSbG+e23TbccCN3s+EchjRjXFokGHLMgFoqErcdSGOQBmph3CDBu02ah+FwIk4t/G+gWs4/Y5C2bLttP7//7PbfPAz/cWuRANsCdNiNNDZpxrbbiQ0HcrcBw+EAHi1vjC0SDNKMt914xmzYc+52MsgvknMMko1n4nRYjuGNDxXJstvOpzE++FF22xbosI0f3lTYyfbh0AIBBkSIjIJRMApGwSggAQAAKA1iL0NJ+QAAAAAASUVORK5CYII=","orcid":"","institution":"T.H. Chan School of Medicine, UMass Chan Medical School","correspondingAuthor":true,"prefix":"","firstName":"Rahul","middleName":"","lastName":"Kumar","suffix":""},{"id":561909990,"identity":"1e6cebd0-4265-4521-a3cb-422a7edda017","order_by":4,"name":"Rohan Phadke","email":"","orcid":"","institution":"Baylor College of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Rohan","middleName":"","lastName":"Phadke","suffix":""},{"id":561909991,"identity":"360a9f91-3862-482f-90f4-eabb51f33f8f","order_by":5,"name":"Swapna Vaja","email":"","orcid":"","institution":"Rush University Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Swapna","middleName":"","lastName":"Vaja","suffix":""},{"id":561909992,"identity":"08561ca1-2bd4-43cd-8e42-99c8361e8fae","order_by":6,"name":"Nathan J. 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Lumbar decompression, a foundational procedure, aims to alleviate neural compression and mitigate associated symptoms such as radiculopathy and neurogenic claudication. Historically, conventional open decompression served as the standard surgical approach. However, advancements in surgical techniques have introduced minimally invasive alternatives, with endoscopic lumbar decompression emerging as a promising option [1]. Initial studies suggest that minimally invasive techniques may offer benefits such as reduced perioperative morbidity, decreased blood loss, and potentially faster recovery times [2\u0026ndash;3]. Despite a growing body of literature, large-scale comparative evidence on the comprehensive safety profiles, including complication rates and healthcare utilization, between endoscopic and conventional open approaches for lumbar decompression, remains a critical gap in the existing research landscape to help guide patient selection and healthcare policy decisions.\u003c/p\u003e \u003cp\u003eConventional open lumbar decompression involves a larger incision, requiring greater dissection of paraspinal musculature to expose the spinal elements. This traditional method, while effective in achieving neural decompression, is often associated with more extensive soft tissue trauma [4]. In contrast, endoscopic lumbar decompression utilizes small incisions and specialized endoscopes, allowing for direct visualization and targeted removal of compressive structures with minimal disruption to surrounding tissues [1]. This approach, often referred to as an \"ultra-minimally invasive\" technique, seeks to preserve spinal stability while achieving adequate decompression [3\u0026ndash;4]. Both techniques share the fundamental objective of relieving pressure on neural elements, thereby improving patient symptoms and functional status.\u003c/p\u003e \u003cp\u003eSurgical interventions for degenerative lumbar disease are inherently associated with various perioperative risks. Perioperative complications such as incidental durotomy, cerebrospinal fluid (CSF) leak, infection, and the need for unplanned reoperation are well-documented across spinal procedures [5\u0026ndash;6]. While minimally invasive techniques are often praised for reducing certain risks, their specific safety profiles in comparison to open surgery, particularly regarding less common but significant events like meningitis or systemic complications such as myocardial infarction and venous thromboembolism, require further investigation. Therefore, understanding the differential rates of these complications is essential for informing surgical practice and patient counseling.\u003c/p\u003e \u003cp\u003eThe primary objective of this investigation was to conduct a comprehensive comparison of 90-day complication rates, unplanned reoperation rates, and patterns of healthcare utilization between endoscopic and conventional open lumbar decompression. This study leveraged TrinetX Research Network, a large deidentified national database, and employed propensity score matching to mitigate selection bias, thereby offering a robust comparative analysis. By examining these critical outcomes, this research aimed to provide valuable insights for clinicians, patients, and healthcare policymakers regarding the relative safety and early-term post-operative course associated with each surgical modality. The findings contribute to an evidence-based understanding of these increasingly utilized surgical approaches.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eA retrospective cohort study was conducted utilizing the TriNetX Research Network. This platform aggregates de-identified electronic health records from 105 U.S. healthcare organizations, encompassing a diverse patient population. As this study involved analysis of de-identified data and did not include any procedures performed on humans or animals beyond routine clinical care, no human or animal subjects were directly involved, and institutional review board approval and informed consent were not required.\u003c/p\u003e \u003cp\u003eAdult patients who underwent lumbar decompression were identified through specific procedure codes. The endoscopic cohort included individuals with codes (see appendix) for percutaneous endoscopic lumbar decompression and discectomy. The non-endoscopic cohort comprised patients undergoing conventional open decompression. The TriNetX platform's 20-year look-back period for index events ensured comprehensive patient history; no patients were excluded based on this criterion.\u003c/p\u003e \u003cp\u003ePatients presenting with concurrent conditions such as fracture, infection, tumor, deformity, or those with alternative decompression codes were systematically excluded from both cohorts to ensure a focused comparison of degenerative lumbar disease. Propensity score matching was then performed at a 1:1 ratio. This methodology balanced baseline characteristics between the endoscopic and open decompression groups. Matching covariates included patient age, sex, race/ethnicity, pre-existing comorbidities, and the specific surgical indication for decompression.\u003c/p\u003e \u003cp\u003eOutcomes were assessed for a 90-day period following the index procedure, starting from day 1. Primary outcomes of interest included incidental durotomy, CSF leak or pseudomeningocele formation, and the occurrence of unplanned reoperation. Secondary outcomes comprised emergency department revisits, inpatient readmissions, length of hospital stay, discharge disposition, meningitis, wound disruption, venous thromboembolism, and myocardial infarction. Superficial and deep surgical site infections were not amenable due to low (\u0026lt;\u0026thinsp;10) count to analysis due to limitations in data export.\u003c/p\u003e \u003cp\u003eAll statistics were run in Trinetx and Excel. Measures of association between the matched cohorts were reported as risk ratios (RR) along with their corresponding 95% confidence intervals (CI). Statistical significance for all comparisons was established at a p-value threshold of less than 0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e33,324 patients were found for the endoscopic group and 181,116 for the non-endoscopic group prior to matching. Following a rigorous propensity score matching process, the study cohorts each consisted of 25,242 patients. This matching is shown in Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u0026amp; \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and ensured that baseline characteristics, including age, sex, race/ethnicity, comorbidities, and surgical indication, were comparable between the endoscopic and open decompression groups, thereby minimizing confounding biases.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient characteristics prior to matching\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEndoscopic (n\u0026thinsp;=\u0026thinsp;33,324)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-endoscopic (n\u0026thinsp;=\u0026thinsp;178,637)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStd diff\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge at Index (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55.5\u0026thinsp;\u0026plusmn;\u0026thinsp;15.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56.3\u0026thinsp;\u0026plusmn;\u0026thinsp;16.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12,406 (43.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67,429 (39.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.084\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16,100 (56.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96,680 (56.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.960\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17,553 (61.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e132,854 (77.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.353\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack or African American, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,722 (6.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11,339 (6.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHispanic or Latino, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e924 (3.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9,643 (5.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.116\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsian, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5,926 (20.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4,246 (2.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.595\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown Race, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,252 (7.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17,600 (10.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.083\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther Race, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e556 (1.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4,375 (2.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.041\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9,291 (32.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68,066 (39.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.150\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,995 (14.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28,442 (16.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.072\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHyperlipidemia, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4,990 (17.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45,656 (26.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.222\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverweight/Obesity, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,198 (7.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32,622 (19.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.338\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTobacco use, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e212 (0.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5,837 (3.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.188\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol use, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45 (0.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,408 (0.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.095\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOpioid-related disorders, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e239 (0.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,890 (1.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.076\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCannabis-related disorders, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e148 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,471 (1.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.094\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSedative/anxiolytic disorders, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (0.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e442 (0.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.037\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCocaine-related disorders, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e117 (0.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e911 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther stimulant disorders, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45 (0.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e480 (0.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHallucinogen disorders, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.390\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNicotine dependence, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,303 (8.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22,448 (13.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.164\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInhalant disorders, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e141 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e778 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.356\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther psychoactive disorders, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e260 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,009 (1.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCKD, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,043 (3.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9,279 (5.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.085\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCOPD, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,129 (4.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8,899 (5.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.059\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeart failure, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e608 (2.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6,126 (3.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.087\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcute myocardial infarction, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e461 (1.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4,212 (2.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.060\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCerebral infarction, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e479 (1.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,618 (2.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTIA, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e512 (1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,413 (2.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpinal stenosis (lumbar), n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10,484 (36.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95,609 (55.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.389\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStenosis without claudication, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,928 (10.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55,599 (32.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.562\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisc displacement lumbar, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11,211 (39.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81,273 (47.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.165\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisc displacement lumbosacral, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7,315 (25.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46,904 (27.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.040\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRadiculopathy lumbar, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6,375 (22.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90,825 (53.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.667\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRadiculopathy lumbosacral, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5,230 (18.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47,243 (27.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.221\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient characteristics after matching\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEndoscopic (n\u0026thinsp;=\u0026thinsp;33,324)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-endoscopic (n\u0026thinsp;=\u0026thinsp;178,637)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStd diff\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge at Index (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55.2\u0026thinsp;\u0026plusmn;\u0026thinsp;15.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.0\u0026thinsp;\u0026plusmn;\u0026thinsp;15.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10,922 (43.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10,894 (43.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.801\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14,269 (56.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14,285 (56.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.886\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17,552 (69.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17,996 (71.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack or African American, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,721 (6.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,575 (6.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHispanic or Latino, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e921 (3.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e825 (3.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsian, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,726 (10.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,685 (10.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.555\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown Race, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,252 (8.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,065 (8.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther Race, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e555 (2.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e520 (2.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.281\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8,100 (32.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7,736 (30.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,349 (13.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,951 (11.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.048\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHyperlipidemia, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4,536 (18.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4,373 (17.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverweight/Obesity, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,160 (8.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,013 (8.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTobacco use, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e212 (0.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e206 (0.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.768\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol use, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45 (0.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (0.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.317\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOpioid-related disorders, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e236 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e172 (0.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCannabis-related disorders, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e148 (0.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e108 (0.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSedative/anxiolytic disorders, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (0.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (0.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCocaine-related disorders, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e114 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79 (0.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther stimulant disorders, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42 (0.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (0.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.245\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHallucinogen disorders, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNicotine dependence, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,263 (9.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,086 (8.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInhalant disorders, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e137 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83 (0.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther psychoactive disorders, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e248 (1.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e177 (0.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCKD, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e809 (3.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e673 (2.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCOPD, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,002 (4.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e791 (3.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeart failure, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e542 (2.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e423 (1.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.034\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcute myocardial infarction, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e437 (1.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e347 (1.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCerebral infarction, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e400 (1.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e346 (1.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTIA, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e396 (1.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e303 (1.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpinal stenosis (lumbar), n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9,090 (36.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8,846 (35.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpinal stenosis without claudication, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,928 (11.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,910 (11.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.802\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisc displacement lumbar, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9,563 (37.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9,219 (36.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisc displacement lumbosacral, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6,469 (25.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6,344 (25.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRadiculopathy lumbar, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6,350 (25.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6,499 (25.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRadiculopathy lumbosacral, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5,200 (20.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5,533 (21.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eEndoscopic decompression demonstrated statistically lower rates for several primary complications compared to open decompression. Incidental durotomy occurred in 0.3% of the endoscopic cohort versus 0.5% in the open cohort (RR 0.55, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Similarly, CSF leak or pseudomeningocele formation was observed in 0.2% of endoscopic cases versus 0.5% of open cases (RR 0.45, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Unplanned reoperation rates were also significantly lower in the endoscopic group, at 0.1% compared to 1.8% in the open group (RR 0.06, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eAnalysis of secondary outcomes revealed mixed results. Healthcare utilization was marginally higher in the endoscopic decompression cohort (7.2% vs 6.8%, RR 1.07, p\u0026thinsp;=\u0026thinsp;0.041). Meningitis also occurred more frequently among patients undergoing endoscopic decompression (0.4% vs 0.3%, RR 1.44, p\u0026thinsp;=\u0026thinsp;0.018). Conversely, no statistically significant differences were detected between the groups for wound disruption (0.7% vs 0.8%, p\u0026thinsp;=\u0026thinsp;0.269), deep vein thrombosis (0.8% vs 0.7%, p\u0026thinsp;=\u0026thinsp;0.193), or myocardial infarction (0.4% vs 0.2%, p\u0026thinsp;=\u0026thinsp;0.356). Overall, endoscopic decompression was associated with significantly lower rates of major surgical complications, though it demonstrated slightly higher rates of postoperative healthcare utilization and meningitis.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e90-day primary and secondary outcomes of endoscopic and open decompression groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEndoscopic (n/N, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-endoscopic or open (n/N, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRisk Difference (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRisk Ratio (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOdds Ratio (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncidental durotomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e74 / 25,242 (0.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e135 / 25,242 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.002 (-0.004, -0.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.548 (0.413, 0.727)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.547 (0.412, 0.726)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCSF leak / pseudomeningocele\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59 / 25,242 (0.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e130 / 25,242 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.003 (-0.004, -0.002)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.454 (0.334, 0.617)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.453 (0.333, 0.616)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnplanned reoperation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25 / 25,242 (0.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e451 / 25,242 (1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.017 (-0.019, -0.015)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.055 (0.037, 0.083)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.054 (0.036, 0.082)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealthcare utilization (ED/IP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,826 / 25,242 (7.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,709 / 25,242 (6.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.005 (0.000, 0.009)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.068 (1.003, 1.139)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.074 (1.003, 1.150)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.041\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeningitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e102 / 25,242 (0.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71 / 25,242 (0.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001 (0.000, 0.002)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.437 (1.062, 1.944)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.438 (1.062, 1.948)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.018\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWound disruption/dehiscence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e171 / 25,242 (0.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e192 / 25,242 (0.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.001 (-0.002, 0.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.891 (0.725, 1.094)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.890 (0.724, 1.094)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.269\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeep vein thrombosis (LE)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e198 / 25,242 (0.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e173 / 25,242 (0.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001 (-0.000, 0.002)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.145 (0.934, 1.402)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.146 (0.934, 1.406)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.193\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMyocardial infarction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e104 / 25,242 (0.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62 / 25,242 (0.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0017 (0.001, 0.003)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.677 (1.225, 2.296)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.680 (1.226, 2.302)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.356\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present large-scale, propensity-matched cohort study indicates that endoscopic lumbar decompression is associated with statistically lower rates of incidental durotomy and CSF leak or pseudomeningocele formation compared to conventional open decompression. Specifically, the incidence of incidental durotomy was nearly halved in the endoscopic group (0.3% vs. 0.5%, RR 0.55), and CSF leak or pseudomeningocele was less than half (0.2% vs. 0.5%, RR 0.45). This statistical difference aligns with the theoretical advantages of minimally invasive techniques, which aim to reduce tissue disruption and enhance visualization of delicate neural structures [1]. However, the absolute differences, though statistically significant, are notably small. A reduction from 0.5% to 0.3% for incidental durotomy, for instance, represents a very modest clinical impact on an individual patient's risk profile. While existing literature reports incidental durotomy rates ranging from 0.5% to 18% in open surgery and 1.7% to 4.3% in endoscopic procedures, the rates observed in this study for both techniques are at the lower end of these ranges, suggesting overall improvements in surgical safety or differences in reporting mechanisms [6].\u003c/p\u003e \u003cp\u003eA particularly striking finding was the significantly lower rate of unplanned reoperation in the endoscopic cohort (0.1% vs. 1.8%, RR 0.06). This almost 18-fold reduction in reoperation risk, even with small absolute percentages, represents a substantial comparative advantage for endoscopic decompression. Unplanned reoperation is a critical patient safety and healthcare utilization metric. Pseudomeningocele formation, often a sequela of incidental durotomy, was also significantly lower in the endoscopic group. The ability of endoscopic techniques to achieve adequate decompression while potentially minimizing trauma to surrounding structures, including the dura, may contribute to these reduced rates [4]. Lower reoperation rates translate into fewer patient morbidities, improved long-term outcomes, and reduced healthcare burden. This specific finding merits further investigation into the underlying mechanisms that confer such a protective effect in the endoscopic group within a 90-day window.\u003c/p\u003e \u003cp\u003eIn contrast to the favorable primary outcomes, the endoscopic group exhibited a slightly higher rate of meningitis (0.4% vs. 0.3%, RR 1.44) and overall healthcare utilization (7.2% vs. 6.8%, RR 1.07). The increased incidence of meningitis in endoscopic procedures, while statistically significant, is based on very low absolute numbers. The precise reasons for this observation warrant deeper investigation. Endoscopic procedures involve continuous irrigation, which, if not meticulously controlled, could theoretically introduce contaminants or lead to fluid extravasation, though typically these are sterile environments. Alternatively, this may reflect differing patient characteristics or post-operative management protocols that were not fully captured by the propensity matching. The marginally higher healthcare utilization in the endoscopic cohort challenges the common perception that minimally invasive surgery invariably leads to lower post-operative resource consumption. While minimally invasive procedures are often associated with shorter hospital stays [7], increased emergency department revisits or outpatient follow-ups for specific complications could collectively contribute to a higher overall utilization rate [8]. The present study did not observe increases in systemic complications such as wound disruption, deep vein thrombosis, or myocardial infarction in the endoscopic cohort, which provides reassurance regarding the systemic safety profile of these procedures.\u003c/p\u003e \u003cp\u003eThe findings of this national cohort study present a nuanced perspective when compared to existing literature. Several meta-analyses and systematic reviews have previously supported the notion that full-endoscopic spinal decompression offers advantages over microscopic decompression, including better leg pain improvement, shorter operative times, and fewer complications [9]. Similarly, some studies comparing endoscopic techniques to other minimally invasive approaches have shown benefits such as shorter hospital stays and improved pain scores for endoscopic patients, despite potentially longer operative times [7]. However, other research has presented more equivocal results. A multicenter comparison using a national database, albeit with a much smaller endoscopic cohort (34 patients), found that endoscopically guided approaches did not significantly reduce adverse events, length of stay, or operative time compared to open techniques [10]. Another retrospective analysis indicated that minimally invasive techniques did not result in increased reoperation or 30- and 90-day readmission rates when compared to open approaches, suggesting similar safety profiles for some metrics [11]. The current study, with its exceptionally large, propensity-matched national cohort, offers a robust dataset that helps clarify some of these previously conflicting observations. Taken together, the demonstration of statistically lower primary complication rates for endoscopic surgery, even with small absolute differences, generally aligns with the trend favoring less invasive approaches in reducing direct surgical morbidity.\u003c/p\u003e \u003cp\u003eThe most significant clinical implication from this study lies in the magnitude of the observed differences. While the statistically significant reductions in incidental durotomy and CSF leak/pseudomeningocele rates are noteworthy, their absolute differences are small. For instance, a 0.2% absolute reduction in incidental durotomy may not translate into a perceived substantial benefit for the average patient or surgeon when considering surgical choice. This contrasts with the more pronounced reductions in hospital length of stay and faster recovery often attributed to minimally invasive techniques in other studies [2]. However, the considerable reduction in unplanned reoperation (from 1.8% to 0.1%) represents a clinically meaningful difference. While still a small absolute percentage, avoiding reoperation has substantial benefits for patient morbidity, recovery trajectory, and overall healthcare costs. The slightly increased rates of meningitis and healthcare utilization in the endoscopic group, though statistically significant, are also of small absolute magnitude. Overall, these results support the safety of endoscopic decompression but indicate its benefits are incremental rather than transformative. Clinical decision-making should therefore balance these subtle differences with other factors, such as patient-specific characteristics, surgeon expertise, and the potential for perceived benefits like smaller incisions and quicker initial recovery, which were not directly measured in this study's outcomes.\u003c/p\u003e \u003cp\u003eThis study possesses several notable strengths. Its foundation in a large, national, de-identified electronic health records network (TriNetX Research Network) provides a real-world perspective on outcomes, encompassing a vast and diverse patient population of 50,000 individuals. The use of propensity score matching to balance baseline characteristics between the endoscopic and open decompression cohorts significantly reduces the risk of selection bias, thereby enhancing the internal validity of the comparative analysis. Furthermore, the 90-day follow-up period allows for capture of early but critical postoperative complications and healthcare utilization patterns. Despite these strengths, certain limitations warrant consideration. The retrospective nature of the study, inherent to database analyses, means that unmeasured confounding variables might exist, even after propensity matching. The reliance on administrative codes for identifying diagnoses and procedures, while robust in a large dataset, can introduce inaccuracies or miss nuances in clinical presentation or surgical technique. For instance, previous research indicates that International Classification of Diseases (ICD) codes for incidental durotomy have limited sensitivity, potentially leading to underreporting of this specific complication [6]. The study also lacked granular data on functional outcomes, such as Visual Analog Scale (VAS) scores or Oswestry Disability Index (ODI), which are crucial for assessing the patient's perspective on surgical success. The inability to analyze superficial and deep surgical site infections due to data export limitations represents another gap in the comprehensive safety profile. Finally, the 90-day follow-up captures early outcomes but does not provide information on long-term complication rates, reoperation beyond 90 days, or sustained functional improvement.\u003c/p\u003e \u003cp\u003eThe findings from this large national cohort study offer valuable data points for clinicians navigating the choice between endoscopic and open lumbar decompression. The statistically lower rates of incidental durotomy, cerebrospinal fluid leak, and unplanned reoperation associated with endoscopic approaches provide some objective support for its safety profile. However, the small absolute differences in these primary outcomes should be interpreted in context of their small absolute effect sizes. For example, while the relative risk reduction for incidental durotomy is considerable, the absolute difference of 0.2% may not be the sole determinant for surgical selection in many cases. Conversely, the statistically higher rates of meningitis and overall healthcare utilization in the endoscopic group, while also small in absolute terms, warrant careful consideration. These findings underscore that while endoscopic techniques offer advantages, they are not without their own distinct, albeit rare, risks and resource implications. Clinicians should integrate these data with individual patient characteristics, including comorbidities, anatomical considerations, and personal preferences. Furthermore, surgeon experience and the learning curve associated with endoscopic techniques are critical factors [12]. For instance, preventing incidental dural tears during the early learning period requires meticulous technique and clear visualization [5]. Ultimately, the decision should be individualized, balancing the modest observed benefits in certain complications against the slight increase in others, alongside other clinical factors and patient expectations. In summary, endoscopic decompression offers a modest but measurable safety advantage over open surgery, supporting its continued adoption while underscoring the need for careful patient selection and technical expertise.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis large, propensity-matched national cohort study compared safety outcomes and early healthcare utilization between endoscopic and open lumbar decompression in over 50,000 patients. Endoscopic decompression was associated with significantly fewer primary surgical complications than open decompression, including statistically lower rates of incidental durotomy, cerebrospinal fluid leak, and unplanned reoperation. Specifically, incidental durotomy occurred in 0.3% of endoscopic cases versus 0.5% of open cases, and CSF leak or pseudomeningocele in 0.2% versus 0.5%. The rate of unplanned reoperation was markedly lower in the endoscopic group at 0.1% compared to 1.8% in the open cohort. However, it is crucial to note that the absolute differences for incidental durotomy and CSF leak were small, suggesting a modest clinical impact for these specific outcomes. These differences, while small in absolute terms, suggest a trend toward improved perioperative safety with endoscopic techniques. Conversely, endoscopic cases exhibited slightly higher rates of overall healthcare utilization (7.2% vs. 6.8%) and meningitis (0.4% vs. 0.3%). No significant differences were observed in systemic complications such as wound disruption, deep vein thrombosis, or myocardial infarction. Overall, these findings affirm the general safety of endoscopic approaches for lumbar decompression, though their early-term advantages over open decompression, though the magnitude of difference was modest..\u003c/p\u003e \u003cp\u003eBeyond the immediate findings, the results of this study offer important implications for both clinical practice and future research endeavors. For clinicians, the data support the safety profile of endoscopic lumbar decompression, indicating that it can be considered a viable alternative to conventional open surgery with a potentially lower risk of reoperation within the early postoperative period. However, the modest absolute differences in some complication rates suggest that patient selection, surgeon expertise, and a balanced discussion of risks and benefits remain paramount in clinical decision-making. For future research, several avenues emerge. Studies with longer-term follow-up are essential to ascertain if the observed early differences in reoperation rates are sustained and how they influence long-term functional outcomes, patient satisfaction, and recurrence rates. Incorporating patient-reported outcome measures (PROMs) such as VAS and ODI would provide a more holistic understanding of surgical efficacy from the patient's perspective. Further investigations should also explore the factors contributing to the slightly elevated meningitis and healthcare utilization rates in the endoscopic group, potentially through more granular data on post-operative management or specific endoscopic techniques. Comparative cost-effectiveness analyses, factoring in both direct surgical costs and downstream healthcare utilization, would also contribute significantly to the literature. In summary, endoscopic lumbar decompression offers a modest but measurable safety advantage over open surgery, supporting its use as a viable minimally invasive alternative pending further long-term validation.\u003c/p\u003e"},{"header":"Declarations","content":" \u003ch2\u003e Conflicts of Interest\u003c/b\u003e:\u003c/h2\u003e \u003cp\u003eThe authors declare no conflicts of interest\u003c/p\u003e \u003ch2\u003eConsent to Participate:\u003c/h2\u003e \u003cp\u003eThis study used de-identified, retrospective data from a national database. Thus, individual consent to participate was not required in accordance with institutional and database use policies.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eClinical trial number\u003c/strong\u003e \u003cp\u003enot applicable.\u003c/p\u003e \u003ch2\u003eEthics Approval/Exemption\u003c/h2\u003e \u003cp\u003e \u003cb\u003e\u003c/b\u003eNot applicable\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eGuideline\u003c/strong\u003e \u003cp\u003eAdherence to STROBE\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eNo funding was involved in this study.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eDana Hazem and Rohit Srinivas conceived and supervised the study design and manuscript drafting and revisions; Harlene Kaur, Rahul Kumar, and Rohan Phadke performed data extraction, statistical analysis, and manuscript drafting and revision; Swapna Vaja assisted with manuscript drafting and revisions; Nathan J. Lee contributed to study design and manuscript revision. All authors reviewed and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgments:\u003c/h2\u003e \u003cp\u003eNone\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThis study used de‑identified patient‑level data licensed from the TriNetX research network (TriNetX Real‑World Dataset; third‑party, de‑identified electronic health record data). The dataset is not publicly available due to contractual and privacy restrictions, but access to similar datasets can be requested directly from TriNetX (https://trinetx.com), and analytic code and aggregated outputs supporting the findings are available from the corresponding author upon reasonable request, subject to TriNetX licensing conditions.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePholprajug, P., Kotheeranurak, V., Liu, Y., \u0026amp; Kim, J.-S. (2023). The Endoscopic Lumbar Interbody Fusion: A Narrative Review, and Future Perspective. Neurospine, 20(4), 1224\u0026ndash;1245. \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ehttps://doi.org/10.14245/ns.2346888.444\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuo, H., Song, Y., Weng, R., Tian, H., Yuan, J., \u0026amp; Li, Y. (2022). Comparison of Clinical Outcomes and Complications Between Endoscopic and Minimally Invasive Transforaminal Lumbar Interbody Fusion for Lumbar Degenerative Diseases: A Systematic Review and Meta-analysis. Global Spine Journal, 13(5), 1394\u0026ndash;1404. \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ehttps://doi.org/10.1177/21925682221142545\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKamson, S. (2017). Full-Endoscopic Assisted Lumbar Decompressive Surgery Performed in an Outpatient, Ambulatory Facility: Report of 5 Years of Complications and Risk Factors. Pain Physician, 20(2), E221\u0026ndash;E231. \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ehttps://doi.org/10.36076/ppj.2017.e231\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim, J.-E., \u0026amp; Choi, D.-J. (2018). Clinical and Radiological Outcomes of Unilateral Biportal Endoscopic Decompression by 30\u0026deg; Arthroscopy in Lumbar Spinal Stenosis: Minimum 2-Year Follow-up. Clinics in Orthopedic Surgery, 10(3), 328. \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ehttps://doi.org/10.4055/cios.2018.10.3.328\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim, H.-S., Wu, P. H., \u0026amp; Jang, I.-T. (2020). Lumbar Endoscopic Unilateral Laminotomy for Bilateral Decompression Outside-In Approach: A Proctorship Guideline With 12 Steps of Effectiveness and Safety. Neurospine, 17(Suppl 1), S99\u0026ndash;S109. \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ehttps://doi.org/10.14245/ns.2040078.039\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eToci, G., Lambrechts, M. J., Issa, T., Karamian, B., Siegel, N., Antonio, N. D., Canseco, J., Kurd, M., Woods, B., Kaye, I. D., Hilibrand, A., Kepler, C., Vaccaro, A., \u0026amp; Schroeder, G. (2023). Incidence, Risk Factors, and Outcomes of Incidental Durotomy during Lumbar Spine Decompression with or without Fusion. Asian Spine Journal, 17(4), 647\u0026ndash;655. \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ehttps://doi.org/10.31616/asj.2022.0297\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcGrath, L. B., White-Dzuro, G. A., \u0026amp; Hofstetter, C. P. (2019). Comparison of clinical outcomes following minimally invasive or lumbar endoscopic unilateral laminotomy for bilateral decompression. Journal of Neurosurgery: Spine, 30(4), 491\u0026ndash;499. \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ehttps://doi.org/10.3171/2018.9.spine18689\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeyendecker, J., Prasse, T., Park, C., K\u0026ouml;ster, M., Rumswinkel, L., Shenker, T., Bieler, E., Eysel, P., Bredow, J., Zaki, M. M., Kathawate, V., Harake, E., Joshi, R. S., Konakondla, S., Kashlan, O. N., Derman, P., Telfeian, A., \u0026amp; Hofstetter, C. P. (2024). 90-Day Emergency Department Utilization and Readmission Rate After Full-Endoscopic Spine Surgery: A Multicenter, Retrospective Analysis of 821 Patients. Neurosurgery, 96(2), 318\u0026ndash;327. \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ehttps://doi.org/10.1227/neu.0000000000003095\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang, Z., Wang, H., Li, W., \u0026amp; Hu, W. (2022). Comparative Effects and Safety of Full-Endoscopic Versus Microscopic Spinal Decompression for Lumbar Spinal Stenosis: A Meta-Analysis and Statistical Power Analysis of 6 Randomized Controlled Trials. Neurospine, 19(4), 996\u0026ndash;1005. \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ehttps://doi.org/10.14245/ns.2244600.300\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChiu, R. G., Patel, S., Zhu, A., Aguilar, E., \u0026amp; Mehta, A. I. (2019). Endoscopic Versus Open Laminectomy for Lumbar Spinal Stenosis: An International, Multi-Institutional Analysis of Outcomes and Adverse Events. Global Spine Journal, 10(6), 720\u0026ndash;728. \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ehttps://doi.org/10.1177/2192568219872157\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAltshuler, M., Mueller, K. B., MacConnell, A., Wirth, P., Sandhu, F. A., \u0026amp; Voyadzis, J.-M. (2020). Reoperation, Readmission, and Discharge Disposition for Patients With Degenerative Lumbar Pathology Treated With Either Open or Minimally Invasive Techniques: A Single-Center Retrospective Review of 1435 Cases. Neurosurgery, 87(6), 1199\u0026ndash;1205. \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ehttps://doi.org/10.1093/neuros/nyaa246\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiounakos, J. I., \u0026amp; Wang, M. Y. (2020). The Endoscopic Approach to Lumbar Discectomy, Fusion, and Enhanced Recovery: A Review. Global Spine Journal, 10(2_suppl), 65S\u0026ndash;69S. \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ehttps://doi.org/10.1177/2192568219884913\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"neurosurgical-review","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nrev","sideBox":"Learn more about [Neurosurgical Review](https://www.springer.com/journal/10143)","snPcode":"10143","submissionUrl":"https://submission.nature.com/new-submission/10143/3","title":"Neurosurgical Review","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Endoscopic spine surgery, lumbar decompression, degenerative spine disease, perioperative complications, surgical outcomes","lastPublishedDoi":"10.21203/rs.3.rs-8244767/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8244767/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e \u003cp\u003eEndoscopic lumbar decompression has emerged as a minimally invasive alternative to open decompression for degenerative lumbar disease. Although prior work suggests potential recovery benefits, large-scale data comparing safety outcomes remain limited. This study compared 90-day complications, reoperation, and healthcare utilization between endoscopic and open lumbar decompression using a national database.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe performed a retrospective cohort study using the TriNetX U.S. Research Network. Adults undergoing lumbar decompression were identified using procedure codes for percutaneous endoscopic decompression or discectomy versus conventional open decompression. Primary outcomes were incidental durotomy, cerebrospinal fluid (CSF) leak or pseudomeningocele, and unplanned reoperation. Secondary outcomes included emergency department revisit, readmission, length of stay, discharge disposition, meningitis, wound disruption, venous thromboembolism, and myocardial infarction. Propensity score matching was performed 1:1 using demographic and clinical covariates.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAfter matching, 25,242 patients were included in each cohort. Endoscopic decompression demonstrated lower rates of incidental durotomy (0.3% vs 0.5%), CSF leak or pseudomeningocele (0.2% vs 0.5%), and unplanned reoperation (0.1% vs 1.8%). Healthcare utilization (7.2% vs 6.8%) and meningitis (0.4% vs 0.3%) were slightly higher in the endoscopic cohort. No significant differences were seen in wound disruption, venous thromboembolism, or myocardial infarction.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eEndoscopic lumbar decompression was associated with lower 90-day rates of select complications and reoperation, though absolute differences were small. Slightly higher utilization and meningitis rates were observed, but systemic complication rates were comparable. Overall, endoscopic decompression appears safe with modest advantages over open surgery.\u003c/p\u003e\u003ch2\u003eLevel of Evidence\u003c/h2\u003e \u003cp\u003eLevel III Retrospective Comparative Cohort Study\u003c/p\u003e","manuscriptTitle":"Endoscopic Versus Open Lumbar Decompression: A Propensity-Matched National Cohort Study of 50,000 Patients with 90-Day Follow-Up","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-18 18:50:31","doi":"10.21203/rs.3.rs-8244767/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-04T18:34:17+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"332446923947248663373569897515652417876","date":"2025-12-16T19:03:59+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-15T19:36:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"174744315393470034534308261438145469413","date":"2025-12-15T13:07:36+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-15T12:04:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"93763090541477164507000671996132289486","date":"2025-12-15T11:42:16+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-15T11:36:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-07T17:34:24+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-04T02:23:31+00:00","index":"","fulltext":""},{"type":"submitted","content":"Neurosurgical Review","date":"2025-11-30T23:14:13+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"neurosurgical-review","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nrev","sideBox":"Learn more about [Neurosurgical Review](https://www.springer.com/journal/10143)","snPcode":"10143","submissionUrl":"https://submission.nature.com/new-submission/10143/3","title":"Neurosurgical Review","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"0790dca1-a444-46cc-b65b-d8b21b18153a","owner":[],"postedDate":"December 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-23T16:04:46+00:00","versionOfRecord":{"articleIdentity":"rs-8244767","link":"https://doi.org/10.1007/s10143-026-04179-z","journal":{"identity":"neurosurgical-review","isVorOnly":false,"title":"Neurosurgical Review"},"publishedOn":"2026-02-21 15:59:30","publishedOnDateReadable":"February 21st, 2026"},"versionCreatedAt":"2025-12-18 18:50:31","video":"","vorDoi":"10.1007/s10143-026-04179-z","vorDoiUrl":"https://doi.org/10.1007/s10143-026-04179-z","workflowStages":[]},"version":"v1","identity":"rs-8244767","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8244767","identity":"rs-8244767","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}