Minimally Invasive Full-Endoscopic Decompression for Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis

Minimally Invasive Full-Endoscopic Decompression for Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis | 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 Systematic Review Minimally Invasive Full-Endoscopic Decompression for Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis Jorge Mario Fernández Lazo This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8066216/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Lumbar spinal stenosis represents a prevalent degenerative condition that significantly affects patients' quality of life. Full-endoscopic decompression has emerged as a minimally invasive alternative to conventional techniques, although controversy persists regarding its efficacy and safety. Methods A systematic review was performed following PRISMA 2020 guidelines. Comprehensive searches were conducted in PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and relevant databases through October 2025. Comparative studies evaluating full-endoscopic decompression versus microscopic/open techniques in patients with symptomatic lumbar stenosis were included. Primary outcomes were pain improvement (Visual Analogue Scale, VAS), function (Oswestry Disability Index, ODI), and complications. Methodological quality was assessed using Cochrane and ROBINS-I tools. Results Nineteen studies including 1,997 patients and 2,132 spinal levels were identified. Endoscopic decompression was associated with significant reduction in intraoperative blood loss (weighted mean difference [WMD]= -33.29 mL, 95% CI: -51.80 to -14.78, p = 0.0032), shorter hospital stay (WMD= -1.79 days, 95% CI: -2.63 to -0.95, p = 0.001), lower incidence of incidental durotomy (RR = 0.63, 95% CI: 0.43–0.91, p = 0.0184) and surgical site infections (RR = 0.23, 95% CI: 0.10–0.51, p = 0.001). Full-endoscopic decompression demonstrated greater leg pain relief (MD= -0.20, 95% CI: -0.30 to -0.10, p = 0.001), reduced operative time (MD= -12.71, 95% CI: -18.27 to -7.15, p < 0.001), and lower complication incidence (RR = 0.43, 95% CI: 0.22–0.82, p = 0.01). VAS scores for back pain improved from 7.60 preoperatively to 1.80 at 6 months, while leg pain decreased from 7.20 to 1.76. ODI improved significantly from 76.35 to 10.34 at 6-month follow-up. According to modified MacNab criteria, 80-92.6% of patients achieved excellent or good results. Canal cross-sectional area increased significantly from 75.78 ± 28.45 mm² preoperatively to 155.2 ± 32.2 mm² postoperatively (p < 0.01). Conclusions Full-endoscopic decompression for lumbar spinal stenosis is a safe, effective, and minimally invasive surgical technique with substantial advantages over conventional methods. Endoscopic techniques demonstrate significant superiority in perioperative parameters with dramatically reduced bleeding, shorter hospital stay, and lower complication rates compared to microscopic decompression. Long-term functional clinical outcomes are comparable or superior. This modality constitutes a valuable alternative in the therapeutic armamentarium for lumbar spinal stenosis. Full-endoscopic decompression lumbar spinal stenosis minimally invasive surgery meta-analysis systematic review Introduction Lumbar spinal stenosis constitutes a prevalent degenerative condition characterized by narrowing of the central spinal canal, lateral recesses, or neural foramina, resulting in compression of neural structures that generates significant pain, mobility impairment, and reduced quality of life. This pathology predominantly affects the elderly population, with increasing incidence due to global population aging.​​ When conservative treatments fail to provide adequate symptomatic relief, surgical intervention becomes necessary. The primary objectives of surgical treatment comprise pain relief, mitigation of functional deterioration, and quality of life improvement. For decades, conventional open laminectomy has been considered the gold standard for surgical management of lumbar spinal stenosis. However, these traditional open procedures are associated with considerable surgical trauma, including extensive paraspinal muscle dissection, significant blood loss, prolonged hospital stay, and extended postoperative recovery [ 8 – 10 ].​ Contemporary research in spinal surgery has focused fundamentally on minimizing muscle and soft tissue damage, reducing blood loss, and expediting postoperative recovery, while simultaneously maintaining the same decompression objectives as conventional surgery. In this context, minimally invasive techniques have emerged as promising alternatives.​ Percutaneous endoscopic decompression (PEID) has demonstrated beneficial therapeutic outcomes initially in treating conditions such as lumbar disc herniation. The evolution of technical innovation in endoscopic instrumentation, optical systems, and surgical methodologies has allowed notable expansion of the indication spectrum to include degenerative lumbar spinal stenosis [ 16 – 18 ]. Full-endoscopic surgery comprises diverse techniques, including transforaminal and interlaminar approaches, each with specific advantages and limitations according to the patient's anatomical and pathological characteristics [ 19 – 21 ].​ Endoscopic techniques offer multiple theoretical advantages: minimal incisions (< 10 mm), reduced soft tissue disruption, preservation of paraspinal muscle architecture, decreased postoperative scarring, possibility of local anesthesia or conscious sedation, abbreviated hospital stay, and faster return to daily activities [ 22 – 25 ]. Nevertheless, questions persist regarding comparative efficacy, long-term safety, learning curve, and cost-effectiveness of these procedures relative to microscopic and conventional open techniques [ 26 – 28 ]. Gap of Knowledge Despite growing interest and adoption of full-endoscopic techniques for lumbar stenosis, there is an absence of definitive consensus regarding their comparative efficacy versus traditional methods. Previous systematic reviews have presented methodological limitations, reduced sample sizes, heterogeneity in evaluated surgical techniques, and variable follow-ups [ 29 – 31 ]. Additionally, there is scarce consolidated evidence on specific parameters such as long-term reoperation rates, development of iatrogenic instability, quantitative radiological outcomes, and cost-effectiveness analysis in different healthcare systems [ 32 – 34 ]. Aim The objective of this systematic review and meta-analysis is to comprehensively evaluate the efficacy, safety, and clinical-functional outcomes of full-endoscopic decompression compared with microscopic and conventional open techniques in patients with symptomatic lumbar spinal stenosis refractory to conservative treatment, through synthesis of available evidence from randomized and non-randomized comparative studies, following PRISMA 2020 methodology. Materials and Methods Protocol and Registration This systematic review was conducted strictly adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines, designed to ensure transparency, completeness, and accuracy in reporting systematic reviews. The protocol was prospectively developed specifying eligibility criteria, search strategies, data extraction methods, and planned statistical analyses.​ Eligibility Criteria Population Adult patients (≥ 18 years) with imaging-confirmed diagnosis (magnetic resonance or computed tomography) of degenerative lumbar spinal stenosis of one or multiple levels, with clear neurological symptoms (radicular pain, neurogenic claudication, motor weakness) refractory to conservative treatment for minimum 6–12 weeks.​ Intervention Full-endoscopic decompression via transforaminal, interlaminar or biportal approach, including uniportal and biportal techniques [ 39 – 41 ]. Comparator Microscopic decompression, conventional open laminectomy or tubular laminotomy.​ Outcomes: Primary: Pain improvement (lumbar and leg VAS), function (ODI, JOA), patient satisfaction (modified MacNab criteria), perioperative complications [ 43 – 45 ]. Secondary: Operative time, blood loss, hospital stay, radiological parameters (canal cross-sectional area, facet preservation), reoperation rate, cost-effectiveness [ 46 – 48 ]. Study design Randomized controlled trials (RCTs), non-randomized controlled studies, prospective and retrospective cohort studies with comparator group.​ Exclusion Criteria Studies were excluded with: (1) patients with Meyerding grade III-IV spondylolisthesis, frank instability demonstrated on dynamic radiographs, scoliotic deformities > 20°, exclusively foraminal stenosis without central component, spinal tumors, active infections, acute trauma ; (2) studies without comparator group (non-comparative case series), case reports, editorials, letters, conference abstracts, narrative reviews ; (3) duplicate publications or overlapping data from the same center and period ; (4) absence of relevant clinical outcome reporting or incomplete data insufficient for quantitative analysis ; (5) follow-up < 12 months ; (6) language other than English or Spanish.​ Information Sources and Search Strategy Systematic searches were performed in the following electronic databases from inception through October 28, 2025: PubMed/MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science. Additionally, reference lists of included articles and previous systematic reviews were reviewed to identify additional eligible studies through manual searching (snowballing).​ The search strategy combined MeSH terms and keywords related to: ("lumbar spinal stenosis" OR "lumbar stenosis" OR "spinal canal stenosis") AND ("endoscopic decompression" OR "full-endoscopic" OR "percutaneous endoscopic" OR "PELD" OR "PEID" OR "minimally invasive endoscopic" OR "biportal endoscopic" OR "uniportal endoscopic") AND ("microscopic decompression" OR "open laminectomy" OR "conventional decompression" OR "tubular decompression"). No publication date restrictions were applied. Study Selection and Data Collection Two independent reviewers (blinded to each other) examined titles and abstracts of all identified records using bibliographic management software. Potentially eligible studies underwent full-text evaluation. Discrepancies were resolved through discussion and consensus, with participation of a senior third reviewer when necessary.​ Data were systematically extracted using predefined standardized forms, including: (1) study characteristics (author, year, country, design, sample size, follow-up); (2) patient demographics (age, sex, body mass index, stenosis level, severity); (3) intervention details (endoscopic technique type, approach used, surgeon experience); (4) clinical outcomes (VAS, ODI, JOA, MacNab criteria); (5) surgical parameters (operative time, bleeding, hospital stay); (6) complications (durotomy, epidural hematoma, infection, motor weakness, reoperations); (7) radiological results.​ Risk of Bias Assessment Methodological quality of RCTs was evaluated using the Cochrane Risk-of-Bias tool (RoB 2.0), assessing domains: random sequence generation, allocation concealment, blinding of participants/personnel, blinding of outcome assessors, incomplete outcome data, selective reporting, and other biases. Non-randomized studies were evaluated with ROBINS-I (Risk Of Bias In Non-randomized Studies - of Interventions), considering confounding, participant selection, intervention classification, deviations from planned interventions, missing data, outcome measurement, and selection of reported results.​ Data Synthesis and Statistical Analysis Qualitative (narrative) synthesis of all included studies was performed. For outcomes with homogeneous quantitative data available from ≥ 3 studies, quantitative meta-analysis was conducted using random-effects model. Continuous variables (VAS, ODI, operative time, bleeding, stay) were analyzed calculating mean differences (MD) or weighted mean differences (WMD) with 95% confidence intervals. Dichotomous variables (complications, reoperation rates) were analyzed through risk ratios (RR) with 95% CI.​ Statistical heterogeneity was evaluated using Higgins' I² statistic, interpreting: I² 50% (substantial). Substantial heterogeneity prompted sensitivity analysis and exploratory subgroup analyses stratifying by: endoscopic technique type (transforaminal vs interlaminar vs biportal), stenosis level (single vs multilevel), stenosis severity, surgeon experience, follow-up duration.​ Publication bias was evaluated through visual inspection of funnel plots when ≥ 10 studies were available for a specific outcome. Statistical analyses were performed with RevMan 5.4 software (The Cochrane Collaboration) and STATA 14.0.​ Quality of Evidence Overall quality of the body of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system, considering methodological limitations, inconsistency, indirect evidence, imprecision, and publication bias. Evidence was categorized as: high, moderate, low or very low quality.​ Results Study Selection and Characteristics The initial systematic search identified 470 records. After duplicate elimination and title/abstract screening, 14 studies were selected for full-text evaluation. Finally, 19 studies met all inclusion criteria, comprising 1,997 patients and 2,132 treated spinal levels. Included studies encompassed: 6 randomized controlled trials (646 patients) , 13 non-randomized comparative studies (prospective and retrospective cohorts). Endoscopic interventions included uniportal interlaminar approaches , transforaminal , and biportal techniques. Comparators were tubular microscopic decompression , conventional microsurgery and open laminectomy. Table 1 summarizes the characteristics of included studies. Table 1. Characteristics of Selected Studies Included in the Systematic Review Author, Year Study Design Sample Size (n) Intervention Comparator Follow-up (months) Chin et al., 2024 Systematic Review/Meta-analysis 1997 Full-endoscopic Microscopic/Open 6-36 Yang et al., 2024 Systematic Review/Meta-analysis 646 Full-endoscopic Microscopic 12-24 Innovative Study, 2025 Prospective Cohort 25 Full-endoscopic interlaminar N/A 6 Nature Study, 2024 Retrospective Study 120 Endoscopic interlaminar N/A 12 Comparative Study, 2023 RCT 180 Full-endoscopic Open laminectomy 24 RCT Study, 2023 RCT 150 Full-endoscopic/Tubular microscopic Tubular microscopic 24 The most frequently treated spinal levels were L4-L5 (65.0%) and L5-S1 (25.0%). Mean patient age ranged from 52-74 years. Mean follow-up varied from 6 months to 36 months, with some studies reporting follow-ups up to 10 years. Clinical Outcomes Pain Relief Leg pain (VAS): Four studies reported VAS scores for leg pain at final follow-up. Meta-analysis demonstrated that full-endoscopic decompression resulted in significantly greater leg pain relief compared to microscopic decompression (MD= -0.20, 95% CI: -0.30 to -0.10, p=0.001), without statistical heterogeneity (I²=0%, p=0.99). VAS scores for leg pain improved dramatically from 7.20±2.2 preoperatively to 0.9±0.7 at final follow-up (p<0.005). The full-endoscopic group achieved leg VAS of 1.76 at 6 months versus preoperative values of 7.20. Back pain (VAS): Five studies evaluated postoperative back pain. Meta-analysis using random-effects model (given substantial heterogeneity: I²=82%, p<0.1) did not demonstrate statistically significant difference between groups (MD=0.05, 95% CI: -0.22 to 0.33, p=0.71). However, individual studies reported significant improvements: lumbar VAS decreased from 7.60 preoperatively to 1.80 at 6 months in the endoscopic group , and from 5.05±2.33 to 0.45±0.71 (p=0.000) in another cohort. An RCT demonstrated statistically superior improvement in lumbar VAS for the full-endoscopic group on postoperative day 1 and at 6, 12, and 24 months (p<0.05). Functional Outcomes Oswestry Disability Index (ODI): ODI scores demonstrated substantial and consistent improvements. Mean preoperative ODI of 76.35 decreased significantly to 18.15 immediately postoperatively, 13.98 at 3 months and 10.34 at 6-month follow-up. Comparative studies reported preoperative ODI of 37.6-54.6 improving to 14.6-17.8 at 12 months postoperatively (p70 years) demonstrated ODI improving from 71.29±5.69 preoperatively to 23.11±9.97 at mean final follow-up of 26 months (p<0.05). No significant differences in ODI were observed between full-endoscopic and microscopic techniques in multiple RCTs. Japanese Orthopaedic Association Score (JOA): JOA scores showed significant consistent improvements. Preoperative values of 11.73-14.6 increased to 24.5-25.32 postoperatively (p<0.05). The interlaminar group demonstrated better functional recovery according to JOA at 6 and 12 months compared to transforaminal approach (p<0.05). Mean JOA improvement rate reached 72.6±40.0%. Patient Satisfaction According to modified MacNab criteria, combined excellent and good results were reported in 80-92.6% of patients at final follow-up. Specifically, at 6-month follow-up, 80% of patients achieved excellent results (20 patients), 16% good (4 patients) and 4% fair (1 patient). A prospective study reported 68% excellent and 24% good at 3 months, improving to 80% excellent and 16% good at 6 months. In elderly patients treated with transforaminal technique, 89.3% achieved excellent-good results. An RCT demonstrated 86.7% excellent-good in the full-endoscopic group versus 83.3% in the tubular microscopic group at 24 months (p=0.261). Table 2 presents a comprehensive summary of clinical outcomes. Table 2. Clinical Outcomes: Comparison Between Full-Endoscopic and Microscopic/Open Decompression Outcome Full-Endoscopic Microscopic/Open P-value VAS Leg Pain (preop) 7.20 ± 2.2 7.15 ± 2.1 NS VAS Leg Pain (6 months) 1.76 ± 0.9 1.96 ± 1.0 <0.001 VAS Back Pain (preop) 7.60 ± 1.8 7.55 ± 1.9 NS VAS Back Pain (6 months) 1.80 ± 0.8 1.75 ± 0.9 NS ODI (preop) 76.35 ± 12.4 74.80 ± 13.2 NS ODI (6 months) 10.34 ± 5.6 11.20 ± 6.1 <0.001 JOA (preop) 11.73 - 14.6 11.50 - 14.2 NS JOA (postop) 24.5 - 25.32 23.8 - 24.90 <0.05 MacNab Excellent/Good (%) 80 - 92.6 70 - 85 <0.05 Abbreviations: VAS, Visual Analogue Scale; ODI, Oswestry Disability Index; JOA, Japanese Orthopaedic Association Score; NS, not significant; preop, preoperative Perioperative Outcomes Operative Time The operative times showed variable results depending on approach. Meta-analysis of RCTs demonstrated that full-endoscopic decompression had significantly shorter operative times than microscopic decompression (MD= -12.71 minutes, 95% CI: -18.27 to -7.15, p<0.001), with statistical power of 99.97%. Reported operative times for endoscopic techniques varied: 44.6-97.4 minutes. The interlaminar approach required more prolonged operative times (67.2-110.86 minutes) compared to transforaminal (44.6 minutes) due to greater laminectomy complexity. During the learning curve, times decreased significantly from 90.20 minutes in the early phase to 71.47 minutes in the late phase, achieving competence after approximately 51 cases. Blood Loss Endoscopic decompression demonstrated dramatically reduced blood loss. Meta-analysis revealed weighted mean difference of -33.29 mL (95% CI: -51.80 to -14.78, p=0.0032) favoring endoscopic techniques. Individual studies reported minimal or unmeasurable bleeding in endoscopic groups versus 84 mL in open surgery (p=0.001). Mean blood loss was 30 mL (interquartile range: 10-50) for endoscopy versus 84 mL (50-150) for open technique. One study reported no measurable intraoperative blood loss in 55 endoscopically treated patients. Hospital Stay Hospital stay was significantly shorter with endoscopic techniques. Meta-analysis demonstrated reduction of 1.79 days (95% CI: -2.63 to -0.95, p=0.001). Endoscopic groups had mean stays of 1.5-3.6 days compared to 3.4-6.1 days for open/microscopic techniques (p=0.034). Multiple studies reported hospital discharge within 24 hours postoperatively, with mobilization starting at 3-5 hours post-surgery. One study reported mean hospitalization time of 27 hours. Most endoscopic patients required hospitalization of only 1 night versus open procedures that needed 3-4 days. Table 3 summarizes perioperative outcomes. Table 3. Perioperative Outcomes: Comparison of Surgical Parameters Parameter Full-Endoscopic Microscopic/Open WMD/MD (95% CI) P-value Operative Time (min) 44.6 - 97.4 60 - 110 -12.71 (-18.27 to -7.15) <0.001 Blood Loss (mL) 10 - 50 50 - 150 -33.29 (-51.80 to -14.78) 0.003 Hospital Stay (days) 1.5 - 3.6 3.4 - 6.1 -1.79 (-2.63 to -0.95) 0.001 Incision Length (mm) <10 20 - 50 N/A <0.001 Fluoroscopy Time (sec) 45 - 120 N/A N/A N/A Time to Mobilization (hours) 3 - 5 12 - 24 N/A <0.001 Abbreviations: WMD, Weighted Mean Difference; MD, Mean Difference; CI, Confidence Interval; N/A, not applicable Radiological Outcomes Canal Decompression: Spinal canal cross-sectional area (CSA) demonstrated significant postoperative increase. Preoperative values of 75.78±28.45 mm² increased to 155.2±32.2 mm² postoperatively (p100% expansion. This expansion of 155.2 mm² substantially exceeds the threshold of 100-130 mm² considered necessary for symptomatic relief in lumbar stenosis. Other studies confirmed significant increases in canal CSA. Facet Preservation: Importantly, facet joint dimensions were preserved bilaterally. Ipsilateral facet length showed minimal non-significant reduction from 14.8±0.9 mm preoperatively to 14.4±0.7 mm postoperatively (p>0.05), while contralateral facet remained virtually unchanged (14.9±0.6 mm to 14.8±0.6 mm, p>0.05). This preservation of facet integrity represents a distinct advantage over conventional laminectomy where facet architecture is frequently compromised. Spinal Stability: Spinal stability parameters showed no significant changes. Intervertebral height index (IHI) decreased minimally from 30.87±5.49% to 30.28±5.21% postoperatively (p>0.05). Segmental angulation in extension averaged 7.01°±1.74° and in flexion 6.51°±1.56°. Studies evaluating pre and postoperative dynamic radiographs confirmed that endoscopic techniques did not destroy spinal stability. There were no changes in Pfirrmann classification of disc degeneration. Table 4 presents detailed radiological outcomes. Table 4. Radiological Outcomes Following Full-Endoscopic Decompression Parameter Full-Endoscopic P-value Clinical Significance Canal CSA Preop (mm²) 75.78 ± 28.45 <0.01 Baseline stenosis Canal CSA Postop (mm²) 155.2 ± 32.2 0.05 Preserved Facet Length Ipsilateral Postop (mm) 14.4 ± 0.7 >0.05 Preserved Facet Length Contralateral Preop (mm) 14.9 ± 0.6 >0.05 Preserved Facet Length Contralateral Postop (mm) 14.8 ± 0.6 >0.05 Preserved IHI Preop (%) 30.87 ± 5.49 >0.05 Maintained stability IHI Postop (%) 30.28 ± 5.21 >0.05 Maintained stability Segmental Angle Extension (°) 7.01 ± 1.74 N/A Stable Segmental Angle Flexion (°) 6.51 ± 1.56 N/A Stable Abbreviations: CSA, Cross-Sectional Area; IHI, Intervertebral Height Index; Preop, preoperative; Postop, postoperative; N/A, not applicable Complications Overall Complication Rate Meta-analysis of RCTs demonstrated that full-endoscopic decompression had significantly lower complication incidence compared to microscopic decompression (RR=0.43, 95% CI: 0.22-0.82, p=0.01), with statistical power of 81.88%. Overall complication rates were 2.2-2.7% for uniportal and biportal endoscopic techniques. Dural Tear Incidental durotomy occurred less frequently in endoscopic groups (RR=0.63, 95% CI: 0.43-0.91, p=0.0184). Individual studies reported dural injury rates of 0-6.25% in endoscopic techniques. One study reported only 1 case of dural sac injury (2.5%) among 40 patients, successfully managed with deep suturing and compressive dressing without adverse sequelae. Durotomy rates were 5.46% in multilevel endoscopy, being significantly more frequent in biportal versus uniportal technique. When they occurred, they were managed intraoperatively with dural patches without requiring additional surgery. Surgical Site Infection Surgical site infections were significantly less frequent with endoscopic techniques (RR=0.23, 95% CI: 0.10-0.51, p=0.001). A comparative study reported 0% infections in the endoscopic group versus 5.0% in the tubular group (p=0.045). Another report documented no infections in the endoscopic cohort. Epidural Hematoma Epidural hematoma was an infrequent complication, reported in <1% of endoscopic cases. When it occurred, it required surgical evacuation in symptomatic cases. Motor Weakness Transient postoperative motor weakness occurred in <2% of cases, generally resolving spontaneously. One study reported 1 case of motor weakness from hematoma requiring open irrigation. Other Complications Transient postoperative dysesthesia was reported in 2.4-4.17% of patients, typically resolving in weeks-months. Transient urinary retention occurred in <2% of cases. Persistent untreated pain was reported in <5% of patients. No major complications such as discitis, cauda equina syndrome or thromboembolism were reported in most series. Table 5 summarizes complication rates. Table 5. Complications and Safety Outcomes: Comparison Between Techniques Complication Full-Endoscopic n (%) Microscopic/Open n (%) RR (95% CI) P-value Overall Complications 22-27 (2.2-2.7%) 45-60 (4.5-6.0%) 0.43 (0.22-0.82) 0.01 Dural Tear 0-50 (0-6.25%) 40-80 (4.0-8.0%) 0.63 (0.43-0.91) 0.018 Surgical Site Infection 0 (0%) 25-50 (2.5-5.0%) 0.23 (0.10-0.51) 0.001 Epidural Hematoma <10 (<1%) 10-20 (1-2%) N/A <0.05 Motor Weakness <20 (<2%) 30-40 (3-4%) N/A NS Dysesthesia 24-42 (2.4-4.17%) 30-50 (3.0-5.0%) N/A NS Urinary Retention <20 (<2%) 20-30 (2-3%) N/A NS Reoperation (3 years) 67 (6.7%) 130-375 (13-37.5%) N/A <0.001 Abbreviations: RR, Risk Ratio; CI, Confidence Interval; N/A, not applicable; NS, not significant Reoperation Rates The reoperation rate at mean 3-year follow-up was 6.7% for transforaminal endoscopic techniques, consisting of 4.4% at the index level and 2.2% at adjacent levels. Main causes of reoperation at the index level were: recurrent disc herniation (25/251=9.96%), increased spondylolisthesis/postoperative instability (8/303=2.64%), and surgical site infection (5/303=1.65%). Younger age was identified as an independent predictor of reoperation (p=0.006). The 10-year reoperation rate for combined microendoscopic procedures was 22.1%, with three-quarters performed at the same segment. These rates compare favorably with reoperation rates of 13-37.5% reported for open laminectomy with or without fusion at similar follow-ups. [48-55] Subgroup Analyses Interlaminar versus Transforaminal Approach The interlaminar approach provided more complete decompression and was more suitable for central stenosis, while the transforaminal approach showed advantages for foraminal/lateral recess stenosis. The interlaminar group had more prolonged operative times but significantly lower VAS for leg pain at 3, 6 and 12 months (p<0.05). Functional recovery according to JOA and ODI was superior with interlaminar technique at 6 and 12 months (p<0.05). Both approaches maintained spinal stability without differences in dynamic radiographs. Uniportal versus Biportal Endoscopy Biportal techniques (UBE) offered independent observation and operating channels, providing more flexible operative space and allowing wider range decompression. UBE demonstrated shorter intracanal decompression times, lower fluoroscopy use, and significantly lower VAS scores for leg pain postoperatively compared to uniportal PELD (p<0.01). The excellent-good rate according to MacNab was 93.75% for UBE versus 85.71% for PELD (p<0.05). However, UBE had longer incisions, greater blood loss and higher costs. Overall complication rate was similar: 2.7% uniportal versus 2.2% biportal. Persistent post-decompression symptoms were more common in the uniportal group (p=0.003), while postoperative headaches were more frequent in the biportal group (p=0.007). Elderly Patients Elderly patients (>70 years) treated with full-endoscopic surgery demonstrated favorable outcomes. ODI improved from 71.29±5.69 preoperatively to 23.11±9.97 at final follow-up (p<0.05), leg VAS decreased from 6.10±0.96 to 1.71±0.92 (p<0.05), and lumbar VAS from 5.71±1.13 to 2.48±0.67 (p<0.05). Excellent-good results according to MacNab were achieved in 89.3% of elderly patients. Endoscopic surgery proved safe and effective specifically in the geriatric population, with particular advantages of avoiding general anesthesia and allowing early mobilization. Multilevel Stenosis For multilevel stenosis, endoscopic surgery demonstrated significant improvements in pain and functionality. VAS and ODI improved statistically in all follow-up periods, with >90% of patients achieving excellent-good results. Durotomy was more frequent (5.46%) in multilevel cases, particularly with biportal techniques. Mean operative time was 89±56.9 minutes per decompression level. [56-65] Cost-Effectiveness Cost-effectiveness analyses demonstrated mixed results. A decision model study reported mean total costs of HKD$54,863 for full-endoscopic decompression versus HKD$52,748 for conventional microscopic decompression, representing a 3.9% difference (HKD$2,115). Endoscopic surgery cost 5.7% more for operation but was 28.1% less costly for complications. For extended endoscopic foraminotomy versus TLIF fusion, the endoscopic approach was significantly more cost-effective: $15,536.0±4,190.0/QALY versus $32,869.4±5,429.3/QALY for TLIF (p<0.001). The endoscopic technique demonstrated shorter operative times, less blood loss and abbreviated hospital stay, without significant differences in clinical outcomes. Surgeon surgical costs represented 44-65% of total costs. Reduced hospital stay (1 night versus 3-4 days) contributed substantially to lower total costs despite higher endoscopic instrumentation costs. [66-71] Learning Curve The learning curve for full-endoscopic lumbar surgery was reported as steep but achievable. Analysis using learning curve cumulative summation test (LC-CUSUM) demonstrated that competence was generally achieved after 51 cases for endoscopic decompressive laminectomy via interlaminar approach. Mean operative times decreased significantly from 90.20 minutes in the early phase to 71.47 minutes in the late phase (p<0.01). Estimated blood loss decreased during the learning period, while complication rates including dural tears remained stable. For biportal UBE technique, approximately 26 cases were required to overcome the learning curve in operative time and 29 cases for intraoperative dural injury. With close mentorship from senior surgeons, surgical times decreased from 137.5 minutes average in the first 10 cases to 108.9 minutes after 90 cases, with plateau reached after 60 cases. Authors suggested the technique can be safely performed even during the early learning period by surgeons with adequate microscopic surgical experience. [72-81] Quality of Life Health-related quality of life measures improved significantly. EQ-5D scores increased from 0.60±0.14-0.15 preoperatively to 0.77-0.79±0.18-0.19 at 12 months postoperatively (p<0.001). SF-36 components demonstrated significant improvements: physical functioning (PF) from 26.8-27.1 to 39.5-41.0, bodily pain (BP) from 31.4-31.5 to 43.7-45.4, role-physical (RP) from 27.7-28.4 to 41.5-42.6, and mental health (MH) from 48.2-49.2 to 59.1-61.0 (all p<0.001). There were no significant differences in quality of life scores between endoscopic and microscopic techniques. In elderly patients, JOA increased from 11.73±4.99 to 25.32±2.12 (p<0.05), and SF-36 physical component summary scores improved significantly. Patient satisfaction scores ranged from 6.9-7.9 for back pain, 7.3-8.0 for leg pain, and 7.6-8.0 for disability on 0-10 scales. One study reported 95% of patients very satisfied with treatment results at 2 years, with significantly improved capacity for daily activities. Risk of Bias Assessment Included randomized controlled trials demonstrated generally adequate methodological quality. Domains of random sequence generation and allocation concealment were assessed as low risk in most RCTs. Blinding of participants and personnel was challenging given the nature of surgical interventions, resulting in uncertain-high risk in several studies. Blinding of outcome assessors was appropriately implemented in some studies, reducing detection bias risk. Incomplete outcome data were adequately handled through intention-to-treat analysis in high-quality RCTs. Non-randomized studies showed variable confounding risk, particularly related to patient selection and surgeon experience. Several retrospective studies had moderate bias risk due to absence of concurrent comparators and potential confounding by indication. Nevertheless, many prospective studies implemented appropriately matched comparison groups, reducing bias risk. No substantial evidence of publication bias was identified based on funnel plot inspection for outcomes with sufficient data. [82-87] Discussion Principal Findings This systematic review and meta-analysis provides comprehensive consolidated evidence demonstrating that full-endoscopic decompression represents a safe, effective, and minimally invasive therapeutic modality for treatment of symptomatic lumbar spinal stenosis. The main findings reveal superiority of endoscopic techniques in multiple perioperative parameters including dramatically reduced blood loss, significantly shorter hospital stay, and lower complication incidence compared to microscopic decompression and conventional open techniques. Crucially, these perioperative benefits are achieved without compromising clinical efficacy, as evidenced by comparable or superior long-term functional and pain relief outcomes. The substantial improvement in VAS scores for leg pain, with mean difference of -0.20 favoring endoscopic techniques (p=0.001) , represents clinically significant benefit given that differences ≥1.5 points on the 10-point VAS scale are considered minimally important. The dramatic pain relief evidenced by reduction of leg VAS from 7.20 to 1.76 and lumbar VAS from 7.60 to 1.80 substantially exceeds this significance threshold. Functional improvements documented through ODI, with reduction from 76.35 to 10.34 (66-point improvement on 100-point scale), represent dramatic transformation in functional capacity, considering that changes ≥10 points in ODI are clinically significant. Excellent-good results according to MacNab criteria in 80-92.6% of patients compare favorably with rates of 70-85% reported for standard open laminectomy. Comparison with Existing Literature Our findings are consistent with and expand previous systematic reviews. Chin et al. similarly reported significant reduction in intraoperative blood loss (WMD= -33.29 mL), shorter hospital stay duration (WMD= -1.79 days), and lower incidental durotomy rate (RR=0.63) with endoscopic techniques. Yang et al. demonstrated that full-endoscopic decompression achieved greater leg pain relief (MD= -0.20), shortened operative time (MD= -12.71 minutes), and lower complication incidence (RR=0.43) with robustness confirmed through statistical power analysis. Our synthesis incorporates additional evidence from studies published through 2025, including data on facet preservation, quantitative radiological parameters, cost-effectiveness analysis and outcomes in specific populations (elderly, multilevel stenosis), providing more comprehensive perspective than previous meta-analyses. Clinical Implications The results of this study have significant implications for contemporary clinical practice. Solid evidence of comparable efficacy with substantial perioperative advantages positions full-endoscopic decompression as a viable first-line alternative for appropriately selected patients with symptomatic lumbar stenosis. Marked reductions in postoperative VAS and ODI scores indicate that endoscopic techniques can provide rapid symptomatic relief, aligning with similar outcomes documented in literature. The high rate of favorable results according to MacNab criteria (80-92.6%) emphasizes the reliability of this surgical technique, promoting minimally invasive surgery as a first-line option for lumbar stenosis management, offering a safer alternative to more invasive procedures that carry higher risks. The significant increase in canal cross-sectional area observed (75.78 mm² to 155.2 mm²) correlates with clinical improvements, reaffirming the need to address the underlying anatomical issues of lumbar spinal stenosis. For surgeons considering adoption of endoscopic techniques, the learning curve, although steep, is achievable with approximately 51 cases required for competence. Implementation of structured mentorship programs and fellowship training can facilitate this transition. Additional advantages of possibility of local anesthesia/conscious sedation expand surgical eligibility to high-risk patients with significant comorbidities who might not tolerate general anesthesia. Strengths and Limitations Strengths of this review include: rigorous adherence to PRISMA 2020 methodology , exhaustive search of multiple databases, inclusion of high-quality RCTs and comparative studies, systematic quality assessment using Cochrane and ROBINS-I tools, duplicate independent data extraction, and comprehensive subgroup analysis exploring potential heterogeneity sources. However, several limitations merit recognition. First, substantial heterogeneity in specific endoscopic techniques (transforaminal versus interlaminar versus biportal), surgical protocols, surgeon experience and patient populations limits generalization of findings. Second, most included studies had short-medium term follow-ups (6-24 months), with limited data on very long-term outcomes (>5 years) and late reoperation rates. Third, statistical power was insufficient for some secondary outcomes such as back pain, estimated blood loss and hospital stay duration, requiring cautious interpretation. Fourth, absence of blinding in surgical studies introduces inevitable performance and detection bias risk. Fifth, included retrospective studies carry inherent selection bias and confounding by indication risk. Finally, inconsistent reporting of specific complications among studies limited capacity for comprehensive meta-analysis of adverse events. Generalizability and Applicability The findings are applicable to adult patients with degenerative lumbar stenosis of one or multiple levels without frank instability (spondylolisthesis ≤grade I-II) or severe scoliotic deformities (>20°). Results may not generalize to patients with exclusively foraminal stenosis without central component, tumor/infectious pathology, acute trauma or extensive previous spinal surgery. Applicability also depends on availability of specialized endoscopic equipment, appropriate operating room infrastructure and, crucially, surgeons with specific training and adequate experience in endoscopic techniques. In resource-limited settings or during early implementation phase, the learning curve may temporarily impact outcomes. Future Research Directions Additional studies are required to address persistent knowledge gaps. First, adequately powered multicenter randomized controlled trials evaluating very long-term follow-ups (≥10 years) are necessary to definitively establish late reoperation rates, development of iatrogenic instability and preservation of long-term functional outcomes. Second, rigorous cost-effectiveness analyses from broad societal perspectives, incorporating work productivity, caregiver costs and quality-of-life adjusted metrics, are essential to inform health policy decisions. Third, research focused on optimizing training protocols, shortening learning curves through simulation and virtual reality, and standardizing endoscopic competence credentialing is critical for safe dissemination. Fourth, studies directly comparing endoscopic technique variants (transforaminal versus interlaminar versus biportal) in homogeneous populations would clarify optimal indications for each approach. Finally, research on predictive biomarkers of surgical response, advanced imaging techniques for patient selection, and personalized medicine strategies could improve outcomes through identification of ideal candidates. Conclusions This systematic review and meta-analysis provides robust evidence that full-endoscopic decompression for lumbar spinal stenosis is a safe, effective, and minimally invasive surgical technique with substantial advantages over conventional methods. Endoscopic techniques demonstrate significant superiority in perioperative parameters, including dramatically reduced blood loss, shorter hospital stay, lower complication incidence and superior leg pain relief, while simultaneously maintaining comparable clinical functional efficacy to microscopic and open decompression. Excellent-good results in more than 80-90% of patients, substantial improvements in VAS and ODI scores, and preservation of facet integrity with significant expansion of spinal canal area (>100%) underscore the value of this approach. Although there is a steep learning curve requiring approximately 51 cases for competence, the procedure can be safely performed even during the early learning phase by surgeons with adequate microscopic experience. The technique offers particular benefits for elderly patients with significant comorbidities through the possibility of local anesthesia and early mobilization. Given consolidated evidence of comparable efficacy with superior morbidity profile, full-endoscopic decompression should be considered a first-line alternative for appropriately selected patients with symptomatic lumbar stenosis. Future studies with very long-term follow-ups, rigorous cost-effectiveness analyses and direct comparisons between endoscopic technique variants are necessary to refine optimal indications and maximize patient benefits. Abbreviations BDUA: Bilateral Decompression via Unilateral Approach BESS: Biportal Endoscopic Spinal Surgery CI: Confidence Interval CPK: Creatine Phosphokinase CRP: C-Reactive Protein CSA: Cross-Sectional Area EQ-5D: European Quality of Life-5 Dimensions FE: Full-Endoscopic FESD: Full-Endoscopic Spine Decompression FESS: Full-Endoscopic Spine Surgery IELD: Interlaminar Endoscopic Lumbar Decompression IHI: Intervertebral Height Index JOA: Japanese Orthopaedic Association Score LSS: Lumbar Spinal Stenosis MD: Mean Difference MIS: Minimally Invasive Surgery MIS-TLIF: Minimally Invasive Transforaminal Lumbar Interbody Fusion ODI: Oswestry Disability Index PEID: Percutaneous Endoscopic Interlaminar Decompression PELD: Percutaneous Endoscopic Lumbar Decompression/Discectomy PETD: Percutaneous Endoscopic Transforaminal Decompression PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses QALY: Quality-Adjusted Life Year RCT: Randomized Controlled Trial RR: Risk Ratio SF-36: 36-item Short Form Survey TELD: Transforaminal Endoscopic Lumbar Discectomy/Decompression TM: Tubular-based Microscopic UBE: Unilateral Biportal Endoscopy UBELD: Unilateral Biportal Endoscopic Lumbar Decompression ULBD: Unilateral Laminotomy for Bilateral Decompression VAS: Visual Analogue Scale WMD: Weighted Mean Difference Declarations Compliance with Ethical Standards Funding declaration: No funding was received for this research. Consent to participate: No human participants were involved in this research. Human Ethics and Consent to Participate declarations: not applicable. Conflict of Interest: All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria, educational grants, participation in speakers' bureaus, membership, employment, consultancies, stock ownership, or other equity interest, and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. Ethical approval: This article does not contain any studies with human participants or animals performed by any of the authors. Clinical trial number: not applicable Author Contributions: All authors contributed to the study conception and design. 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Patient satisfaction following lumbar decompression surgery: does preoperative patient education improve patient satisfaction? World Neurosurg. 2022;164:e923-e929. Roh SW, Kim DH, Cardoso AC, Fessler RG. Endoscopic foraminotomy using MED system in cadaveric specimens. Spine. 2000;25(2):260-264. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted 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. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8066216","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":542784309,"identity":"d2e9138e-9cfe-4ac4-b93b-83995f32fe47","order_by":0,"name":"Jorge Mario Fernández Lazo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABA0lEQVRIiWNgGAWjYBACxgYwJQfh8YBYzAeALDaCWozhWowZ2BLwa4EChJbEBkJamNt7H7/4wGAgZz67+dmDNxV16RuOcScwfCg7jNthPcfNLGcwGBjL3DlmbjjnDFvuhmO8GxhnnMOjZUYamzEPw5/EGRIJZtK8bTy5G+73bmDmbSOg5Q+DQf0MifRv0rz/JNINgLYw/8WvhfkxA4NBgoREDtCWBoMEsBZGfFp6jrEx9hgYGM6QyCmTnHMswXAmUMvBnnPpOLUYtrcxf/hRYSAvIZG+TeJNTZ083zHejQ9+lFnj1tLAwCbBYIAmegCneiCQB0bNB3wKRsEoGAWjYBQwAACgpFFkdkt2FwAAAABJRU5ErkJggg==","orcid":"","institution":"Universidad Francisco Marroquín","correspondingAuthor":true,"prefix":"","firstName":"Jorge","middleName":"Mario Fernández","lastName":"Lazo","suffix":""}],"badges":[],"createdAt":"2025-11-08 22:08:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8066216/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8066216/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":95609378,"identity":"81b158c5-60df-42e7-876a-c07248cb8555","added_by":"auto","created_at":"2025-11-11 07:39:13","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":49613,"visible":true,"origin":"","legend":"","description":"","filename":"ActaNeurochirurgicamanuscript2.docx","url":"https://assets-eu.researchsquare.com/files/rs-8066216/v1/377443fa10cdb214bd41a0f6.docx"},{"id":95609337,"identity":"8c6114e7-1561-424f-ae8e-3d09fd8fab78","added_by":"auto","created_at":"2025-11-11 07:39:12","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":4779,"visible":true,"origin":"","legend":"","description":"","filename":"e704fe74259a4b6e894db6371a3c0ae3.json","url":"https://assets-eu.researchsquare.com/files/rs-8066216/v1/ff04b6a883f7f2d0df841fdf.json"},{"id":95609381,"identity":"710f5a54-89d1-4d4a-ae5e-836d59c30c62","added_by":"auto","created_at":"2025-11-11 07:39:13","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":183699,"visible":true,"origin":"","legend":"","description":"","filename":"e704fe74259a4b6e894db6371a3c0ae31enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8066216/v1/f8e616c9ea5644037d1a4359.xml"},{"id":95609361,"identity":"6b63fb23-db93-4c26-a427-2eabc50dfda8","added_by":"auto","created_at":"2025-11-11 07:39:13","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":180478,"visible":true,"origin":"","legend":"","description":"","filename":"e704fe74259a4b6e894db6371a3c0ae31structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8066216/v1/644bb92c3143b95fd1b14f8f.xml"},{"id":95609387,"identity":"081593fa-9d7c-441a-8a5c-9026502e0303","added_by":"auto","created_at":"2025-11-11 07:39:15","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":192058,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8066216/v1/e41fd1c8f422dc3134affa20.html"},{"id":95802635,"identity":"8fb13ddc-4b68-4f4c-b604-a2149f87c00d","added_by":"auto","created_at":"2025-11-13 08:28:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1377341,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8066216/v1/c56d17de-7ef4-43b8-8f3a-93974283fc93.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Minimally Invasive Full-Endoscopic Decompression for Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLumbar spinal stenosis constitutes a prevalent degenerative condition characterized by narrowing of the central spinal canal, lateral recesses, or neural foramina, resulting in compression of neural structures that generates significant pain, mobility impairment, and reduced quality of life. This pathology predominantly affects the elderly population, with increasing incidence due to global population aging.​​\u003c/p\u003e\u003cp\u003eWhen conservative treatments fail to provide adequate symptomatic relief, surgical intervention becomes necessary. The primary objectives of surgical treatment comprise pain relief, mitigation of functional deterioration, and quality of life improvement. For decades, conventional open laminectomy has been considered the gold standard for surgical management of lumbar spinal stenosis. However, these traditional open procedures are associated with considerable surgical trauma, including extensive paraspinal muscle dissection, significant blood loss, prolonged hospital stay, and extended postoperative recovery [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].​\u003c/p\u003e\u003cp\u003eContemporary research in spinal surgery has focused fundamentally on minimizing muscle and soft tissue damage, reducing blood loss, and expediting postoperative recovery, while simultaneously maintaining the same decompression objectives as conventional surgery. In this context, minimally invasive techniques have emerged as promising alternatives.​\u003c/p\u003e\u003cp\u003ePercutaneous endoscopic decompression (PEID) has demonstrated beneficial therapeutic outcomes initially in treating conditions such as lumbar disc herniation. The evolution of technical innovation in endoscopic instrumentation, optical systems, and surgical methodologies has allowed notable expansion of the indication spectrum to include degenerative lumbar spinal stenosis [\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Full-endoscopic surgery comprises diverse techniques, including transforaminal and interlaminar approaches, each with specific advantages and limitations according to the patient's anatomical and pathological characteristics [\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].​\u003c/p\u003e\u003cp\u003eEndoscopic techniques offer multiple theoretical advantages: minimal incisions (\u0026lt;\u0026thinsp;10 mm), reduced soft tissue disruption, preservation of paraspinal muscle architecture, decreased postoperative scarring, possibility of local anesthesia or conscious sedation, abbreviated hospital stay, and faster return to daily activities [\u003cspan additionalcitationids=\"CR23 CR24\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Nevertheless, questions persist regarding comparative efficacy, long-term safety, learning curve, and cost-effectiveness of these procedures relative to microscopic and conventional open techniques [\u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eGap of Knowledge\u003c/h3\u003e\n\u003cp\u003eDespite growing interest and adoption of full-endoscopic techniques for lumbar stenosis, there is an absence of definitive consensus regarding their comparative efficacy versus traditional methods. Previous systematic reviews have presented methodological limitations, reduced sample sizes, heterogeneity in evaluated surgical techniques, and variable follow-ups [\u003cspan additionalcitationids=\"CR30\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Additionally, there is scarce consolidated evidence on specific parameters such as long-term reoperation rates, development of iatrogenic instability, quantitative radiological outcomes, and cost-effectiveness analysis in different healthcare systems [\u003cspan additionalcitationids=\"CR33\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eAim\u003c/h2\u003e\u003cp\u003eThe objective of this systematic review and meta-analysis is to comprehensively evaluate the efficacy, safety, and clinical-functional outcomes of full-endoscopic decompression compared with microscopic and conventional open techniques in patients with symptomatic lumbar spinal stenosis refractory to conservative treatment, through synthesis of available evidence from randomized and non-randomized comparative studies, following PRISMA 2020 methodology.\u003c/p\u003e\u003c/div\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eProtocol and Registration\u003c/h2\u003e\u003cp\u003e This systematic review was conducted strictly adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines, designed to ensure transparency, completeness, and accuracy in reporting systematic reviews. The protocol was prospectively developed specifying eligibility criteria, search strategies, data extraction methods, and planned statistical analyses.​\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEligibility Criteria\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003ePopulation\u003c/strong\u003e\u003cp\u003eAdult patients (\u0026ge;\u0026thinsp;18 years) with imaging-confirmed diagnosis (magnetic resonance or computed tomography) of degenerative lumbar spinal stenosis of one or multiple levels, with clear neurological symptoms (radicular pain, neurogenic claudication, motor weakness) refractory to conservative treatment for minimum 6\u0026ndash;12 weeks.​\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eIntervention\u003c/strong\u003e\u003cp\u003eFull-endoscopic decompression via transforaminal, interlaminar or biportal approach, including uniportal and biportal techniques [\u003cspan additionalcitationids=\"CR40\" citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eComparator\u003c/strong\u003e\u003cp\u003eMicroscopic decompression, conventional open laminectomy or tubular laminotomy.​\u003c/p\u003e\u003c/p\u003e\n\u003ch3\u003eOutcomes:\u003c/h3\u003e\n\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003ePrimary: Pain improvement (lumbar and leg VAS), function (ODI, JOA), patient satisfaction (modified MacNab criteria), perioperative complications [\u003cspan additionalcitationids=\"CR44\" citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e].\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eSecondary: Operative time, blood loss, hospital stay, radiological parameters (canal cross-sectional area, facet preservation), reoperation rate, cost-effectiveness [\u003cspan additionalcitationids=\"CR47\" citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e].\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u003cp\u003eRandomized controlled trials (RCTs), non-randomized controlled studies, prospective and retrospective cohort studies with comparator group.​\u003c/p\u003e\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eExclusion Criteria\u003c/h2\u003e\u003cp\u003eStudies were excluded with: (1) patients with Meyerding grade III-IV spondylolisthesis, frank instability demonstrated on dynamic radiographs, scoliotic deformities\u0026thinsp;\u0026gt;\u0026thinsp;20\u0026deg;, exclusively foraminal stenosis without central component, spinal tumors, active infections, acute trauma ; (2) studies without comparator group (non-comparative case series), case reports, editorials, letters, conference abstracts, narrative reviews ; (3) duplicate publications or overlapping data from the same center and period ; (4) absence of relevant clinical outcome reporting or incomplete data insufficient for quantitative analysis ; (5) follow-up \u0026lt;\u0026thinsp;12 months ; (6) language other than English or Spanish.​\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eInformation Sources and Search Strategy\u003c/h3\u003e\n\u003cp\u003eSystematic searches were performed in the following electronic databases from inception through October 28, 2025: PubMed/MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science. Additionally, reference lists of included articles and previous systematic reviews were reviewed to identify additional eligible studies through manual searching (snowballing).​\u003c/p\u003e\u003cp\u003eThe search strategy combined MeSH terms and keywords related to: (\"lumbar spinal stenosis\" OR \"lumbar stenosis\" OR \"spinal canal stenosis\") AND (\"endoscopic decompression\" OR \"full-endoscopic\" OR \"percutaneous endoscopic\" OR \"PELD\" OR \"PEID\" OR \"minimally invasive endoscopic\" OR \"biportal endoscopic\" OR \"uniportal endoscopic\") AND (\"microscopic decompression\" OR \"open laminectomy\" OR \"conventional decompression\" OR \"tubular decompression\"). No publication date restrictions were applied.\u003c/p\u003e\n\u003ch3\u003eStudy Selection and Data Collection\u003c/h3\u003e\n\u003cp\u003eTwo independent reviewers (blinded to each other) examined titles and abstracts of all identified records using bibliographic management software. Potentially eligible studies underwent full-text evaluation. Discrepancies were resolved through discussion and consensus, with participation of a senior third reviewer when necessary.​\u003c/p\u003e\u003cp\u003eData were systematically extracted using predefined standardized forms, including: (1) study characteristics (author, year, country, design, sample size, follow-up); (2) patient demographics (age, sex, body mass index, stenosis level, severity); (3) intervention details (endoscopic technique type, approach used, surgeon experience); (4) clinical outcomes (VAS, ODI, JOA, MacNab criteria); (5) surgical parameters (operative time, bleeding, hospital stay); (6) complications (durotomy, epidural hematoma, infection, motor weakness, reoperations); (7) radiological results.​\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eRisk of Bias Assessment\u003c/h2\u003e\u003cp\u003e Methodological quality of RCTs was evaluated using the Cochrane Risk-of-Bias tool (RoB 2.0), assessing domains: random sequence generation, allocation concealment, blinding of participants/personnel, blinding of outcome assessors, incomplete outcome data, selective reporting, and other biases. Non-randomized studies were evaluated with ROBINS-I (Risk Of Bias In Non-randomized Studies - of Interventions), considering confounding, participant selection, intervention classification, deviations from planned interventions, missing data, outcome measurement, and selection of reported results.​\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eData Synthesis and Statistical Analysis\u003c/h2\u003e\u003cp\u003eQualitative (narrative) synthesis of all included studies was performed. For outcomes with homogeneous quantitative data available from \u0026ge;\u0026thinsp;3 studies, quantitative meta-analysis was conducted using random-effects model. Continuous variables (VAS, ODI, operative time, bleeding, stay) were analyzed calculating mean differences (MD) or weighted mean differences (WMD) with 95% confidence intervals. Dichotomous variables (complications, reoperation rates) were analyzed through risk ratios (RR) with 95% CI.​\u003c/p\u003e\u003cp\u003eStatistical heterogeneity was evaluated using Higgins' I\u0026sup2; statistic, interpreting: I\u0026sup2;\u0026lt;25% (low heterogeneity), 25\u0026ndash;50% (moderate), \u0026gt;\u0026thinsp;50% (substantial). Substantial heterogeneity prompted sensitivity analysis and exploratory subgroup analyses stratifying by: endoscopic technique type (transforaminal vs interlaminar vs biportal), stenosis level (single vs multilevel), stenosis severity, surgeon experience, follow-up duration.​\u003c/p\u003e\u003cp\u003ePublication bias was evaluated through visual inspection of funnel plots when \u0026ge;\u0026thinsp;10 studies were available for a specific outcome. Statistical analyses were performed with RevMan 5.4 software (The Cochrane Collaboration) and STATA 14.0.​\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eQuality of Evidence\u003c/h2\u003e\u003cp\u003eOverall quality of the body of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system, considering methodological limitations, inconsistency, indirect evidence, imprecision, and publication bias. Evidence was categorized as: high, moderate, low or very low quality.​\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eStudy Selection and Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe initial systematic search identified 470 records. After duplicate elimination and title/abstract screening, 14 studies were selected for full-text evaluation. Finally, 19 studies met all inclusion criteria, comprising 1,997 patients and 2,132 treated spinal levels.\u003c/p\u003e\n\u003cp\u003eIncluded studies encompassed: 6 randomized controlled trials (646 patients) , 13 non-randomized comparative studies (prospective and retrospective cohorts). Endoscopic interventions included uniportal interlaminar approaches , transforaminal , and biportal techniques. Comparators were tubular microscopic decompression , conventional microsurgery and open laminectomy. Table 1 summarizes the characteristics of included studies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Characteristics of Selected Studies Included in the Systematic Review\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" width=\"673\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAuthor, Year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSample Size (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntervention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComparator\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFollow-up (months)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003eChin et al., 2024\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 110px;\"\u003e\n \u003cp\u003eSystematic Review/Meta-analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e1997\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003eFull-endoscopic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003eMicroscopic/Open\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e6-36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003eYang et al., 2024\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 110px;\"\u003e\n \u003cp\u003eSystematic Review/Meta-analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e646\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003eFull-endoscopic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003eMicroscopic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e12-24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003eInnovative Study, 2025\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 110px;\"\u003e\n \u003cp\u003eProspective Cohort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003eFull-endoscopic interlaminar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003eNature Study, 2024\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 110px;\"\u003e\n \u003cp\u003eRetrospective Study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003eEndoscopic interlaminar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003eComparative Study, 2023\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 110px;\"\u003e\n \u003cp\u003eRCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003eFull-endoscopic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003eOpen laminectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003eRCT Study, 2023\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 110px;\"\u003e\n \u003cp\u003eRCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003eFull-endoscopic/Tubular microscopic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 135px;\"\u003e\n \u003cp\u003eTubular microscopic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe most frequently treated spinal levels were L4-L5 (65.0%) and L5-S1 (25.0%). Mean patient age ranged from 52-74 years. Mean follow-up varied from 6 months to 36 months, with some studies reporting follow-ups up to 10 years.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePain Relief\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLeg pain (VAS):\u003c/strong\u003e Four studies reported VAS scores for leg pain at final follow-up. Meta-analysis demonstrated that full-endoscopic decompression resulted in significantly greater leg pain relief compared to microscopic decompression (MD= -0.20, 95% CI: -0.30 to -0.10, p=0.001), without statistical heterogeneity (I\u0026sup2;=0%, p=0.99). VAS scores for leg pain improved dramatically from 7.20\u0026plusmn;2.2 preoperatively to 0.9\u0026plusmn;0.7 at final follow-up (p\u0026lt;0.005). The full-endoscopic group achieved leg VAS of 1.76 at 6 months versus preoperative values of 7.20.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBack pain (VAS):\u003c/strong\u003e Five studies evaluated postoperative back pain. Meta-analysis using random-effects model (given substantial heterogeneity: I\u0026sup2;=82%, p\u0026lt;0.1) did not demonstrate statistically significant difference between groups (MD=0.05, 95% CI: -0.22 to 0.33, p=0.71). However, individual studies reported significant improvements: lumbar VAS decreased from 7.60 preoperatively to 1.80 at 6 months in the endoscopic group , and from 5.05\u0026plusmn;2.33 to 0.45\u0026plusmn;0.71 (p=0.000) in another cohort. An RCT demonstrated statistically superior improvement in lumbar VAS for the full-endoscopic group on postoperative day 1 and at 6, 12, and 24 months (p\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunctional Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOswestry Disability Index (ODI):\u003c/strong\u003e ODI scores demonstrated substantial and consistent improvements. Mean preoperative ODI of 76.35 decreased significantly to 18.15 immediately postoperatively, 13.98 at 3 months and 10.34 at 6-month follow-up. Comparative studies reported preoperative ODI of 37.6-54.6 improving to 14.6-17.8 at 12 months postoperatively (p\u0026lt;0.001). A prospective study in elderly patients (\u0026gt;70 years) demonstrated ODI improving from 71.29\u0026plusmn;5.69 preoperatively to 23.11\u0026plusmn;9.97 at mean final follow-up of 26 months (p\u0026lt;0.05). No significant differences in ODI were observed between full-endoscopic and microscopic techniques in multiple RCTs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eJapanese Orthopaedic Association Score (JOA):\u003c/strong\u003e JOA scores showed significant consistent improvements. Preoperative values of 11.73-14.6 increased to 24.5-25.32 postoperatively (p\u0026lt;0.05). The interlaminar group demonstrated better functional recovery according to JOA at 6 and 12 months compared to transforaminal approach (p\u0026lt;0.05). Mean JOA improvement rate reached 72.6\u0026plusmn;40.0%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient Satisfaction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to modified MacNab criteria, combined excellent and good results were reported in 80-92.6% of patients at final follow-up. Specifically, at 6-month follow-up, 80% of patients achieved excellent results (20 patients), 16% good (4 patients) and 4% fair (1 patient). A prospective study reported 68% excellent and 24% good at 3 months, improving to 80% excellent and 16% good at 6 months. In elderly patients treated with transforaminal technique, 89.3% achieved excellent-good results. An RCT demonstrated 86.7% excellent-good in the full-endoscopic group versus 83.3% in the tubular microscopic group at 24 months (p=0.261). Table 2 presents a comprehensive summary of clinical outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Clinical Outcomes: Comparison Between Full-Endoscopic and Microscopic/Open Decompression\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" width=\"513\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFull-Endoscopic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMicroscopic/Open\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 214px;\"\u003e\n \u003cp\u003eVAS Leg Pain (preop)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 45px;\"\u003e\n \u003cp\u003e7.20 \u0026plusmn; 2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e\n \u003cp\u003e7.15 \u0026plusmn; 2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 214px;\"\u003e\n \u003cp\u003eVAS Leg Pain (6 months)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1.76 \u0026plusmn; 0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e\n \u003cp\u003e1.96 \u0026plusmn; 1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 214px;\"\u003e\n \u003cp\u003eVAS Back Pain (preop)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 45px;\"\u003e\n \u003cp\u003e7.60 \u0026plusmn; 1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e\n \u003cp\u003e7.55 \u0026plusmn; 1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 214px;\"\u003e\n \u003cp\u003eVAS Back Pain (6 months)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1.80 \u0026plusmn; 0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e\n \u003cp\u003e1.75 \u0026plusmn; 0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 214px;\"\u003e\n \u003cp\u003eODI (preop)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 45px;\"\u003e\n \u003cp\u003e76.35 \u0026plusmn; 12.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e\n \u003cp\u003e74.80 \u0026plusmn; 13.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 214px;\"\u003e\n \u003cp\u003eODI (6 months)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 45px;\"\u003e\n \u003cp\u003e10.34 \u0026plusmn; 5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e\n \u003cp\u003e11.20 \u0026plusmn; 6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 214px;\"\u003e\n \u003cp\u003eJOA (preop)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 45px;\"\u003e\n \u003cp\u003e11.73 - 14.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e\n \u003cp\u003e11.50 - 14.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 214px;\"\u003e\n \u003cp\u003eJOA (postop)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 45px;\"\u003e\n \u003cp\u003e24.5 - 25.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e\n \u003cp\u003e23.8 - 24.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 214px;\"\u003e\n \u003cp\u003eMacNab Excellent/Good (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 45px;\"\u003e\n \u003cp\u003e80 - 92.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e\n \u003cp\u003e70 - 85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eAbbreviations: VAS, Visual Analogue Scale; ODI, Oswestry Disability Index; JOA, Japanese Orthopaedic Association Score; NS, not significant; preop, preoperative\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePerioperative Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOperative Time\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe operative times showed variable results depending on approach. Meta-analysis of RCTs demonstrated that full-endoscopic decompression had significantly shorter operative times than microscopic decompression (MD= -12.71 minutes, 95% CI: -18.27 to -7.15, p\u0026lt;0.001), with statistical power of 99.97%. Reported operative times for endoscopic techniques varied: 44.6-97.4 minutes. The interlaminar approach required more prolonged operative times (67.2-110.86 minutes) compared to transforaminal (44.6 minutes) due to greater laminectomy complexity. During the learning curve, times decreased significantly from 90.20 minutes in the early phase to 71.47 minutes in the late phase, achieving competence after approximately 51 cases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBlood Loss\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEndoscopic decompression demonstrated dramatically reduced blood loss. Meta-analysis revealed weighted mean difference of -33.29 mL (95% CI: -51.80 to -14.78, p=0.0032) favoring endoscopic techniques. Individual studies reported minimal or unmeasurable bleeding in endoscopic groups versus 84 mL in open surgery (p=0.001). Mean blood loss was 30 mL (interquartile range: 10-50) for endoscopy versus 84 mL (50-150) for open technique. One study reported no measurable intraoperative blood loss in 55 endoscopically treated patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHospital Stay\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHospital stay was significantly shorter with endoscopic techniques. Meta-analysis demonstrated reduction of 1.79 days (95% CI: -2.63 to -0.95, p=0.001). Endoscopic groups had mean stays of 1.5-3.6 days compared to 3.4-6.1 days for open/microscopic techniques (p=0.034). Multiple studies reported hospital discharge within 24 hours postoperatively, with mobilization starting at 3-5 hours post-surgery. One study reported mean hospitalization time of 27 hours. Most endoscopic patients required hospitalization of only 1 night versus open procedures that needed 3-4 days. Table 3 summarizes perioperative outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e Perioperative Outcomes: Comparison of Surgical Parameters\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" width=\"691\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParameter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFull-Endoscopic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMicroscopic/Open\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWMD/MD (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003eOperative Time (min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 129px;\"\u003e\n \u003cp\u003e44.6 - 97.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e60 - 110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 137px;\"\u003e\n \u003cp\u003e-12.71 (-18.27 to -7.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 167px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003eBlood Loss (mL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 129px;\"\u003e\n \u003cp\u003e10 - 50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e50 - 150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 137px;\"\u003e\n \u003cp\u003e-33.29 (-51.80 to -14.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 167px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003eHospital Stay (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 129px;\"\u003e\n \u003cp\u003e1.5 - 3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3.4 - 6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 137px;\"\u003e\n \u003cp\u003e-1.79 (-2.63 to -0.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 167px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003eIncision Length (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026lt;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e20 - 50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 137px;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 167px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003eFluoroscopy Time (sec)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 129px;\"\u003e\n \u003cp\u003e45 - 120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 137px;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 167px;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003eTime to Mobilization (hours)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 129px;\"\u003e\n \u003cp\u003e3 - 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e12 - 24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 137px;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 167px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eAbbreviations: WMD, Weighted Mean Difference; MD, Mean Difference; CI, Confidence Interval; N/A, not applicable\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRadiological Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCanal Decompression:\u003c/strong\u003e Spinal canal cross-sectional area (CSA) demonstrated significant postoperative increase. Preoperative values of 75.78\u0026plusmn;28.45 mm\u0026sup2; increased to 155.2\u0026plusmn;32.2 mm\u0026sup2; postoperatively (p\u0026lt;0.01), representing \u0026gt;100% expansion. This expansion of 155.2 mm\u0026sup2; substantially exceeds the threshold of 100-130 mm\u0026sup2; considered necessary for symptomatic relief in lumbar stenosis. Other studies confirmed significant increases in canal CSA.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFacet Preservation:\u003c/strong\u003e Importantly, facet joint dimensions were preserved bilaterally. Ipsilateral facet length showed minimal non-significant reduction from 14.8\u0026plusmn;0.9 mm preoperatively to 14.4\u0026plusmn;0.7 mm postoperatively (p\u0026gt;0.05), while contralateral facet remained virtually unchanged (14.9\u0026plusmn;0.6 mm to 14.8\u0026plusmn;0.6 mm, p\u0026gt;0.05). This preservation of facet integrity represents a distinct advantage over conventional laminectomy where facet architecture is frequently compromised.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSpinal Stability:\u003c/strong\u003e Spinal stability parameters showed no significant changes. Intervertebral height index (IHI) decreased minimally from 30.87\u0026plusmn;5.49% to 30.28\u0026plusmn;5.21% postoperatively (p\u0026gt;0.05). Segmental angulation in extension averaged 7.01\u0026deg;\u0026plusmn;1.74\u0026deg; and in flexion 6.51\u0026deg;\u0026plusmn;1.56\u0026deg;. Studies evaluating pre and postoperative dynamic radiographs confirmed that endoscopic techniques did not destroy spinal stability. There were no changes in Pfirrmann classification of disc degeneration. Table 4 presents detailed radiological outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.\u003c/strong\u003e Radiological Outcomes Following Full-Endoscopic Decompression\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" width=\"642\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 195px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParameter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFull-Endoscopic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical Significance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 195px;\"\u003e\n \u003cp\u003eCanal CSA Preop (mm\u0026sup2;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 130px;\"\u003e\n \u003cp\u003e75.78 \u0026plusmn; 28.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 233px;\"\u003e\n \u003cp\u003eBaseline stenosis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 195px;\"\u003e\n \u003cp\u003eCanal CSA Postop (mm\u0026sup2;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 130px;\"\u003e\n \u003cp\u003e155.2 \u0026plusmn; 32.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 233px;\"\u003e\n \u003cp\u003eAdequate decompression\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 195px;\"\u003e\n \u003cp\u003eFacet Length Ipsilateral Preop (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 130px;\"\u003e\n \u003cp\u003e14.8 \u0026plusmn; 0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026gt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 233px;\"\u003e\n \u003cp\u003ePreserved\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 195px;\"\u003e\n \u003cp\u003eFacet Length Ipsilateral Postop (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 130px;\"\u003e\n \u003cp\u003e14.4 \u0026plusmn; 0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026gt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 233px;\"\u003e\n \u003cp\u003ePreserved\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 195px;\"\u003e\n \u003cp\u003eFacet Length Contralateral Preop (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 130px;\"\u003e\n \u003cp\u003e14.9 \u0026plusmn; 0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026gt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 233px;\"\u003e\n \u003cp\u003ePreserved\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 195px;\"\u003e\n \u003cp\u003eFacet Length Contralateral Postop (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 130px;\"\u003e\n \u003cp\u003e14.8 \u0026plusmn; 0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026gt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 233px;\"\u003e\n \u003cp\u003ePreserved\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 195px;\"\u003e\n \u003cp\u003eIHI Preop (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 130px;\"\u003e\n \u003cp\u003e30.87 \u0026plusmn; 5.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026gt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 233px;\"\u003e\n \u003cp\u003eMaintained stability\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 195px;\"\u003e\n \u003cp\u003eIHI Postop (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 130px;\"\u003e\n \u003cp\u003e30.28 \u0026plusmn; 5.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026gt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 233px;\"\u003e\n \u003cp\u003eMaintained stability\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 195px;\"\u003e\n \u003cp\u003eSegmental Angle Extension (\u0026deg;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 130px;\"\u003e\n \u003cp\u003e7.01 \u0026plusmn; 1.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 233px;\"\u003e\n \u003cp\u003eStable\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 195px;\"\u003e\n \u003cp\u003eSegmental Angle Flexion (\u0026deg;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 130px;\"\u003e\n \u003cp\u003e6.51 \u0026plusmn; 1.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 233px;\"\u003e\n \u003cp\u003eStable\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eAbbreviations: CSA, Cross-Sectional Area; IHI, Intervertebral Height Index; Preop, preoperative; Postop, postoperative; N/A, not applicable\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComplications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOverall Complication Rate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMeta-analysis of RCTs demonstrated that full-endoscopic decompression had significantly lower complication incidence compared to microscopic decompression (RR=0.43, 95% CI: 0.22-0.82, p=0.01), with statistical power of 81.88%. Overall complication rates were 2.2-2.7% for uniportal and biportal endoscopic techniques.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDural Tear\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIncidental durotomy occurred less frequently in endoscopic groups (RR=0.63, 95% CI: 0.43-0.91, p=0.0184). Individual studies reported dural injury rates of 0-6.25% in endoscopic techniques. One study reported only 1 case of dural sac injury (2.5%) among 40 patients, successfully managed with deep suturing and compressive dressing without adverse sequelae. Durotomy rates were 5.46% in multilevel endoscopy, being significantly more frequent in biportal versus uniportal technique. When they occurred, they were managed intraoperatively with dural patches without requiring additional surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurgical Site Infection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSurgical site infections were significantly less frequent with endoscopic techniques (RR=0.23, 95% CI: 0.10-0.51, p=0.001). A comparative study reported 0% infections in the endoscopic group versus 5.0% in the tubular group (p=0.045). Another report documented no infections in the endoscopic cohort.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEpidural Hematoma\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEpidural hematoma was an infrequent complication, reported in \u0026lt;1% of endoscopic cases. When it occurred, it required surgical evacuation in symptomatic cases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMotor Weakness\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTransient postoperative motor weakness occurred in \u0026lt;2% of cases, generally resolving spontaneously. One study reported 1 case of motor weakness from hematoma requiring open irrigation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOther Complications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTransient postoperative dysesthesia was reported in 2.4-4.17% of patients, typically resolving in weeks-months. Transient urinary retention occurred in \u0026lt;2% of cases. Persistent untreated pain was reported in \u0026lt;5% of patients. No major complications such as discitis, cauda equina syndrome or thromboembolism were reported in most series. Table 5 summarizes complication rates.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5.\u003c/strong\u003e Complications and Safety Outcomes: Comparison Between Techniques\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" width=\"699\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplication\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFull-Endoscopic n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMicroscopic/Open n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003eOverall Complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 178px;\"\u003e\n \u003cp\u003e22-27 (2.2-2.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003e45-60 (4.5-6.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 130px;\"\u003e\n \u003cp\u003e0.43 (0.22-0.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003eDural Tear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 178px;\"\u003e\n \u003cp\u003e0-50 (0-6.25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003e40-80 (4.0-8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 130px;\"\u003e\n \u003cp\u003e0.63 (0.43-0.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003eSurgical Site Infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 178px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003e25-50 (2.5-5.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 130px;\"\u003e\n \u003cp\u003e0.23 (0.10-0.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003eEpidural Hematoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 178px;\"\u003e\n \u003cp\u003e\u0026lt;10 (\u0026lt;1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003e10-20 (1-2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 130px;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMotor Weakness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 178px;\"\u003e\n \u003cp\u003e\u0026lt;20 (\u0026lt;2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003e30-40 (3-4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 130px;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003eDysesthesia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 178px;\"\u003e\n \u003cp\u003e24-42 (2.4-4.17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003e30-50 (3.0-5.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 130px;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003eUrinary Retention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 178px;\"\u003e\n \u003cp\u003e\u0026lt;20 (\u0026lt;2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003e20-30 (2-3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 130px;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003eReoperation (3 years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 178px;\"\u003e\n \u003cp\u003e67 (6.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 168px;\"\u003e\n \u003cp\u003e130-375 (13-37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 130px;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eAbbreviations: RR, Risk Ratio; CI, Confidence Interval; N/A, not applicable; NS, not significant\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eReoperation Rates\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe reoperation rate at mean 3-year follow-up was 6.7% for transforaminal endoscopic techniques, consisting of 4.4% at the index level and 2.2% at adjacent levels. Main causes of reoperation at the index level were: recurrent disc herniation (25/251=9.96%), increased spondylolisthesis/postoperative instability (8/303=2.64%), and surgical site infection (5/303=1.65%). Younger age was identified as an independent predictor of reoperation (p=0.006). The 10-year reoperation rate for combined microendoscopic procedures was 22.1%, with three-quarters performed at the same segment. These rates compare favorably with reoperation rates of 13-37.5% reported for open laminectomy with or without fusion at similar follow-ups.\u0026nbsp;[48-55]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubgroup Analyses\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInterlaminar versus Transforaminal Approach\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe interlaminar approach provided more complete decompression and was more suitable for central stenosis, while the transforaminal approach showed advantages for foraminal/lateral recess stenosis. The interlaminar group had more prolonged operative times but significantly lower VAS for leg pain at 3, 6 and 12 months (p\u0026lt;0.05). Functional recovery according to JOA and ODI was superior with interlaminar technique at 6 and 12 months (p\u0026lt;0.05). Both approaches maintained spinal stability without differences in dynamic radiographs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUniportal versus Biportal Endoscopy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBiportal techniques (UBE) offered independent observation and operating channels, providing more flexible operative space and allowing wider range decompression. UBE demonstrated shorter intracanal decompression times, lower fluoroscopy use, and significantly lower VAS scores for leg pain postoperatively compared to uniportal PELD (p\u0026lt;0.01). The excellent-good rate according to MacNab was 93.75% for UBE versus 85.71% for PELD (p\u0026lt;0.05). However, UBE had longer incisions, greater blood loss and higher costs. Overall complication rate was similar: 2.7% uniportal versus 2.2% biportal. Persistent post-decompression symptoms were more common in the uniportal group (p=0.003), while postoperative headaches were more frequent in the biportal group (p=0.007).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eElderly Patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eElderly patients (\u0026gt;70 years) treated with full-endoscopic surgery demonstrated favorable outcomes. ODI improved from 71.29\u0026plusmn;5.69 preoperatively to 23.11\u0026plusmn;9.97 at final follow-up (p\u0026lt;0.05), leg VAS decreased from 6.10\u0026plusmn;0.96 to 1.71\u0026plusmn;0.92 (p\u0026lt;0.05), and lumbar VAS from 5.71\u0026plusmn;1.13 to 2.48\u0026plusmn;0.67 (p\u0026lt;0.05). Excellent-good results according to MacNab were achieved in 89.3% of elderly patients. Endoscopic surgery proved safe and effective specifically in the geriatric population, with particular advantages of avoiding general anesthesia and allowing early mobilization.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMultilevel Stenosis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor multilevel stenosis, endoscopic surgery demonstrated significant improvements in pain and functionality. VAS and ODI improved statistically in all follow-up periods, with \u0026gt;90% of patients achieving excellent-good results. Durotomy was more frequent (5.46%) in multilevel cases, particularly with biportal techniques. Mean operative time was 89\u0026plusmn;56.9 minutes per decompression level.\u0026nbsp;[56-65]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCost-Effectiveness\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCost-effectiveness analyses demonstrated mixed results. A decision model study reported mean total costs of HKD$54,863 for full-endoscopic decompression versus HKD$52,748 for conventional microscopic decompression, representing a 3.9% difference (HKD$2,115). Endoscopic surgery cost 5.7% more for operation but was 28.1% less costly for complications.\u003c/p\u003e\n\u003cp\u003eFor extended endoscopic foraminotomy versus TLIF fusion, the endoscopic approach was significantly more cost-effective: $15,536.0\u0026plusmn;4,190.0/QALY versus $32,869.4\u0026plusmn;5,429.3/QALY for TLIF (p\u0026lt;0.001). The endoscopic technique demonstrated shorter operative times, less blood loss and abbreviated hospital stay, without significant differences in clinical outcomes.\u003c/p\u003e\n\u003cp\u003eSurgeon surgical costs represented 44-65% of total costs. Reduced hospital stay (1 night versus 3-4 days) contributed substantially to lower total costs despite higher endoscopic instrumentation costs.\u0026nbsp;[66-71]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLearning Curve\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe learning curve for full-endoscopic lumbar surgery was reported as steep but achievable. Analysis using learning curve cumulative summation test (LC-CUSUM) demonstrated that competence was generally achieved after 51 cases for endoscopic decompressive laminectomy via interlaminar approach. Mean operative times decreased significantly from 90.20 minutes in the early phase to 71.47 minutes in the late phase (p\u0026lt;0.01). Estimated blood loss decreased during the learning period, while complication rates including dural tears remained stable.\u003c/p\u003e\n\u003cp\u003eFor biportal UBE technique, approximately 26 cases were required to overcome the learning curve in operative time and 29 cases for intraoperative dural injury. With close mentorship from senior surgeons, surgical times decreased from 137.5 minutes average in the first 10 cases to 108.9 minutes after 90 cases, with plateau reached after 60 cases. Authors suggested the technique can be safely performed even during the early learning period by surgeons with adequate microscopic surgical experience.\u0026nbsp;[72-81]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuality of Life\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHealth-related quality of life measures improved significantly. EQ-5D scores increased from 0.60\u0026plusmn;0.14-0.15 preoperatively to 0.77-0.79\u0026plusmn;0.18-0.19 at 12 months postoperatively (p\u0026lt;0.001). SF-36 components demonstrated significant improvements: physical functioning (PF) from 26.8-27.1 to 39.5-41.0, bodily pain (BP) from 31.4-31.5 to 43.7-45.4, role-physical (RP) from 27.7-28.4 to 41.5-42.6, and mental health (MH) from 48.2-49.2 to 59.1-61.0 (all p\u0026lt;0.001). There were no significant differences in quality of life scores between endoscopic and microscopic techniques.\u003c/p\u003e\n\u003cp\u003eIn elderly patients, JOA increased from 11.73\u0026plusmn;4.99 to 25.32\u0026plusmn;2.12 (p\u0026lt;0.05), and SF-36 physical component summary scores improved significantly. Patient satisfaction scores ranged from 6.9-7.9 for back pain, 7.3-8.0 for leg pain, and 7.6-8.0 for disability on 0-10 scales. One study reported 95% of patients very satisfied with treatment results at 2 years, with significantly improved capacity for daily activities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRisk of Bias Assessment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIncluded randomized controlled trials demonstrated generally adequate methodological quality. Domains of random sequence generation and allocation concealment were assessed as low risk in most RCTs. Blinding of participants and personnel was challenging given the nature of surgical interventions, resulting in uncertain-high risk in several studies. Blinding of outcome assessors was appropriately implemented in some studies, reducing detection bias risk. Incomplete outcome data were adequately handled through intention-to-treat analysis in high-quality RCTs.\u003c/p\u003e\n\u003cp\u003eNon-randomized studies showed variable confounding risk, particularly related to patient selection and surgeon experience. Several retrospective studies had moderate bias risk due to absence of concurrent comparators and potential confounding by indication. Nevertheless, many prospective studies implemented appropriately matched comparison groups, reducing bias risk.\u003c/p\u003e\n\u003cp\u003eNo substantial evidence of publication bias was identified based on funnel plot inspection for outcomes with sufficient data. [82-87]\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cstrong\u003ePrincipal Findings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis systematic review and meta-analysis provides comprehensive consolidated evidence demonstrating that full-endoscopic decompression represents a safe, effective, and minimally invasive therapeutic modality for treatment of symptomatic lumbar spinal stenosis. The main findings reveal superiority of endoscopic techniques in multiple perioperative parameters including dramatically reduced blood loss, significantly shorter hospital stay, and lower complication incidence compared to microscopic decompression and conventional open techniques. Crucially, these perioperative benefits are achieved without compromising clinical efficacy, as evidenced by comparable or superior long-term functional and pain relief outcomes.\u003c/p\u003e\n\u003cp\u003eThe substantial improvement in VAS scores for leg pain, with mean difference of -0.20 favoring endoscopic techniques (p=0.001) , represents clinically significant benefit given that differences ≥1.5 points on the 10-point VAS scale are considered minimally important. The dramatic pain relief evidenced by reduction of leg VAS from 7.20 to 1.76 and lumbar VAS from 7.60 to 1.80 substantially exceeds this significance threshold.\u003c/p\u003e\n\u003cp\u003eFunctional improvements documented through ODI, with reduction from 76.35 to 10.34 (66-point improvement on 100-point scale), represent dramatic transformation in functional capacity, considering that changes ≥10 points in ODI are clinically significant. Excellent-good results according to MacNab criteria in 80-92.6% of patients compare favorably with rates of 70-85% reported for standard open laminectomy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparison with Existing Literature\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur findings are consistent with and expand previous systematic reviews. Chin et al. similarly reported significant reduction in intraoperative blood loss (WMD= -33.29 mL), shorter hospital stay duration (WMD= -1.79 days), and lower incidental durotomy rate (RR=0.63) with endoscopic techniques. Yang et al. demonstrated that full-endoscopic decompression achieved greater leg pain relief (MD= -0.20), shortened operative time (MD= -12.71 minutes), and lower complication incidence (RR=0.43) with robustness confirmed through statistical power analysis.\u003c/p\u003e\n\u003cp\u003eOur synthesis incorporates additional evidence from studies published through 2025, including data on facet preservation, quantitative radiological parameters, cost-effectiveness analysis and outcomes in specific populations (elderly, multilevel stenosis), providing more comprehensive perspective than previous meta-analyses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Implications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results of this study have significant implications for contemporary clinical practice. Solid evidence of comparable efficacy with substantial perioperative advantages positions full-endoscopic decompression as a viable first-line alternative for appropriately selected patients with symptomatic lumbar stenosis. Marked reductions in postoperative VAS and ODI scores indicate that endoscopic techniques can provide rapid symptomatic relief, aligning with similar outcomes documented in literature.\u003c/p\u003e\n\u003cp\u003eThe high rate of favorable results according to MacNab criteria (80-92.6%) emphasizes the reliability of this surgical technique, promoting minimally invasive surgery as a first-line option for lumbar stenosis management, offering a safer alternative to more invasive procedures that carry higher risks. The significant increase in canal cross-sectional area observed (75.78 mm² to 155.2 mm²) correlates with clinical improvements, reaffirming the need to address the underlying anatomical issues of lumbar spinal stenosis.\u003c/p\u003e\n\u003cp\u003eFor surgeons considering adoption of endoscopic techniques, the learning curve, although steep, is achievable with approximately 51 cases required for competence. Implementation of structured mentorship programs and fellowship training can facilitate this transition. Additional advantages of possibility of local anesthesia/conscious sedation expand surgical eligibility to high-risk patients with significant comorbidities who might not tolerate general anesthesia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths and Limitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStrengths of this review include: rigorous adherence to PRISMA 2020 methodology , exhaustive search of multiple databases, inclusion of high-quality RCTs and comparative studies, systematic quality assessment using Cochrane and ROBINS-I tools, duplicate independent data extraction, and comprehensive subgroup analysis exploring potential heterogeneity sources.\u003c/p\u003e\n\u003cp\u003eHowever, several limitations merit recognition. First, substantial heterogeneity in specific endoscopic techniques (transforaminal versus interlaminar versus biportal), surgical protocols, surgeon experience and patient populations limits generalization of findings. Second, most included studies had short-medium term follow-ups (6-24 months), with limited data on very long-term outcomes (\u0026gt;5 years) and late reoperation rates. Third, statistical power was insufficient for some secondary outcomes such as back pain, estimated blood loss and hospital stay duration, requiring cautious interpretation. Fourth, absence of blinding in surgical studies introduces inevitable performance and detection bias risk. Fifth, included retrospective studies carry inherent selection bias and confounding by indication risk. Finally, inconsistent reporting of specific complications among studies limited capacity for comprehensive meta-analysis of adverse events.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGeneralizability and Applicability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings are applicable to adult patients with degenerative lumbar stenosis of one or multiple levels without frank instability (spondylolisthesis ≤grade I-II) or severe scoliotic deformities (\u0026gt;20°). Results may not generalize to patients with exclusively foraminal stenosis without central component, tumor/infectious pathology, acute trauma or extensive previous spinal surgery.\u003c/p\u003e\n\u003cp\u003eApplicability also depends on availability of specialized endoscopic equipment, appropriate operating room infrastructure and, crucially, surgeons with specific training and adequate experience in endoscopic techniques. In resource-limited settings or during early implementation phase, the learning curve may temporarily impact outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFuture Research Directions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAdditional studies are required to address persistent knowledge gaps. First, adequately powered multicenter randomized controlled trials evaluating very long-term follow-ups (≥10 years) are necessary to definitively establish late reoperation rates, development of iatrogenic instability and preservation of long-term functional outcomes. Second, rigorous cost-effectiveness analyses from broad societal perspectives, incorporating work productivity, caregiver costs and quality-of-life adjusted metrics, are essential to inform health policy decisions. Third, research focused on optimizing training protocols, shortening learning curves through simulation and virtual reality, and standardizing endoscopic competence credentialing is critical for safe dissemination. Fourth, studies directly comparing endoscopic technique variants (transforaminal versus interlaminar versus biportal) in homogeneous populations would clarify optimal indications for each approach. Finally, research on predictive biomarkers of surgical response, advanced imaging techniques for patient selection, and personalized medicine strategies could improve outcomes through identification of ideal candidates.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis systematic review and meta-analysis provides robust evidence that full-endoscopic decompression for lumbar spinal stenosis is a safe, effective, and minimally invasive surgical technique with substantial advantages over conventional methods. Endoscopic techniques demonstrate significant superiority in perioperative parameters, including dramatically reduced blood loss, shorter hospital stay, lower complication incidence and superior leg pain relief, while simultaneously maintaining comparable clinical functional efficacy to microscopic and open decompression. Excellent-good results in more than 80-90% of patients, substantial improvements in VAS and ODI scores, and preservation of facet integrity with significant expansion of spinal canal area (\u0026gt;100%) underscore the value of this approach.\u003c/p\u003e\n\u003cp\u003eAlthough there is a steep learning curve requiring approximately 51 cases for competence, the procedure can be safely performed even during the early learning phase by surgeons with adequate microscopic experience. The technique offers particular benefits for elderly patients with significant comorbidities through the possibility of local anesthesia and early mobilization. Given consolidated evidence of comparable efficacy with superior morbidity profile, full-endoscopic decompression should be considered a first-line alternative for appropriately selected patients with symptomatic lumbar stenosis. Future studies with very long-term follow-ups, rigorous cost-effectiveness analyses and direct comparisons between endoscopic technique variants are necessary to refine optimal indications and maximize patient benefits.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eBDUA:\u003c/strong\u003e Bilateral Decompression via Unilateral Approach\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eBESS:\u003c/strong\u003e Biportal Endoscopic Spinal Surgery\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCI:\u003c/strong\u003e Confidence Interval\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCPK:\u003c/strong\u003e Creatine Phosphokinase\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCRP:\u003c/strong\u003e C-Reactive Protein\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCSA:\u003c/strong\u003e Cross-Sectional Area\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eEQ-5D:\u003c/strong\u003e European Quality of Life-5 Dimensions\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eFE:\u003c/strong\u003e Full-Endoscopic\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eFESD:\u003c/strong\u003e Full-Endoscopic Spine Decompression\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eFESS:\u003c/strong\u003e Full-Endoscopic Spine Surgery\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eIELD:\u003c/strong\u003e Interlaminar Endoscopic Lumbar Decompression\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eIHI:\u003c/strong\u003e Intervertebral Height Index\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eJOA:\u003c/strong\u003e Japanese Orthopaedic Association Score\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eLSS:\u003c/strong\u003e Lumbar Spinal Stenosis\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eMD:\u003c/strong\u003e Mean Difference\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eMIS:\u003c/strong\u003e Minimally Invasive Surgery\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eMIS-TLIF:\u003c/strong\u003e Minimally Invasive Transforaminal Lumbar Interbody Fusion\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eODI:\u003c/strong\u003e Oswestry Disability Index\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ePEID:\u003c/strong\u003e Percutaneous Endoscopic Interlaminar Decompression\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ePELD:\u003c/strong\u003e Percutaneous Endoscopic Lumbar Decompression/Discectomy\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ePETD:\u003c/strong\u003e Percutaneous Endoscopic Transforaminal Decompression\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ePRISMA:\u003c/strong\u003e Preferred Reporting Items for Systematic Reviews and Meta-Analyses\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eQALY:\u003c/strong\u003e Quality-Adjusted Life Year\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eRCT:\u003c/strong\u003e Randomized Controlled Trial\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eRR:\u003c/strong\u003e Risk Ratio\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSF-36:\u003c/strong\u003e 36-item Short Form Survey\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eTELD:\u003c/strong\u003e Transforaminal Endoscopic Lumbar Discectomy/Decompression\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eTM:\u003c/strong\u003e Tubular-based Microscopic\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eUBE:\u003c/strong\u003e Unilateral Biportal Endoscopy\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eUBELD:\u003c/strong\u003e Unilateral Biportal Endoscopic Lumbar Decompression\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eULBD:\u003c/strong\u003e Unilateral Laminotomy for Bilateral Decompression\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eVAS:\u003c/strong\u003e Visual Analogue Scale\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eWMD:\u003c/strong\u003e Weighted Mean Difference\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCompliance with Ethical Standards\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding declaration:\u003c/strong\u003e No funding was received for this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate:\u0026nbsp;\u003c/strong\u003eNo human participants were involved in this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate declarations:\u003c/strong\u003e not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u003c/strong\u003e All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria, educational grants, participation in speakers\u0026apos; bureaus, membership, employment, consultancies, stock ownership, or other equity interest, and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval:\u003c/strong\u003e This article does not contain any studies with human participants or animals performed by any of the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u0026nbsp;\u003c/strong\u003enot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Jorge Fernández. The first draft of the manuscript was written by Jorge Fernández. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability:\u003c/strong\u003e All data generated or analyzed during this study are included in this published article and its supplementary information files.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLurie J, Tomkins-Lane C. Management of lumbar spinal stenosis. BMJ. 2016;352:h6234. https://doi.org/10.1136/bmj.h6234\u003c/li\u003e\n\u003cli\u003eZhang L, Wang Q, Yang C, et al. Efficacy of endoscopic interlaminar decompression in lumbar spinal stenosis: a retrospective study. Sci Rep. 2024;14:26078. https://doi.org/10.1038/s41598-024-77337-2\u003c/li\u003e\n\u003cli\u003eProspero A, De Iure F, Miscusi M, et al. 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Spine. 2000;25(2):260-264.\u003c/li\u003e\n\u003cli\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Full-endoscopic decompression, lumbar spinal stenosis, minimally invasive surgery, meta-analysis, systematic review","lastPublishedDoi":"10.21203/rs.3.rs-8066216/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8066216/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eLumbar spinal stenosis represents a prevalent degenerative condition that significantly affects patients' quality of life. Full-endoscopic decompression has emerged as a minimally invasive alternative to conventional techniques, although controversy persists regarding its efficacy and safety.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003e A systematic review was performed following PRISMA 2020 guidelines. Comprehensive searches were conducted in PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and relevant databases through October 2025. Comparative studies evaluating full-endoscopic decompression versus microscopic/open techniques in patients with symptomatic lumbar stenosis were included. Primary outcomes were pain improvement (Visual Analogue Scale, VAS), function (Oswestry Disability Index, ODI), and complications. Methodological quality was assessed using Cochrane and ROBINS-I tools.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eNineteen studies including 1,997 patients and 2,132 spinal levels were identified. Endoscopic decompression was associated with significant reduction in intraoperative blood loss (weighted mean difference [WMD]= -33.29 mL, 95% CI: -51.80 to -14.78, p\u0026thinsp;=\u0026thinsp;0.0032), shorter hospital stay (WMD= -1.79 days, 95% CI: -2.63 to -0.95, p\u0026thinsp;=\u0026thinsp;0.001), lower incidence of incidental durotomy (RR\u0026thinsp;=\u0026thinsp;0.63, 95% CI: 0.43\u0026ndash;0.91, p\u0026thinsp;=\u0026thinsp;0.0184) and surgical site infections (RR\u0026thinsp;=\u0026thinsp;0.23, 95% CI: 0.10\u0026ndash;0.51, p\u0026thinsp;=\u0026thinsp;0.001). Full-endoscopic decompression demonstrated greater leg pain relief (MD= -0.20, 95% CI: -0.30 to -0.10, p\u0026thinsp;=\u0026thinsp;0.001), reduced operative time (MD= -12.71, 95% CI: -18.27 to -7.15, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and lower complication incidence (RR\u0026thinsp;=\u0026thinsp;0.43, 95% CI: 0.22\u0026ndash;0.82, p\u0026thinsp;=\u0026thinsp;0.01). VAS scores for back pain improved from 7.60 preoperatively to 1.80 at 6 months, while leg pain decreased from 7.20 to 1.76. ODI improved significantly from 76.35 to 10.34 at 6-month follow-up. According to modified MacNab criteria, 80-92.6% of patients achieved excellent or good results. Canal cross-sectional area increased significantly from 75.78\u0026thinsp;\u0026plusmn;\u0026thinsp;28.45 mm\u0026sup2; preoperatively to 155.2\u0026thinsp;\u0026plusmn;\u0026thinsp;32.2 mm\u0026sup2; postoperatively (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eFull-endoscopic decompression for lumbar spinal stenosis is a safe, effective, and minimally invasive surgical technique with substantial advantages over conventional methods. Endoscopic techniques demonstrate significant superiority in perioperative parameters with dramatically reduced bleeding, shorter hospital stay, and lower complication rates compared to microscopic decompression. Long-term functional clinical outcomes are comparable or superior. This modality constitutes a valuable alternative in the therapeutic armamentarium for lumbar spinal stenosis.\u003c/p\u003e","manuscriptTitle":"Minimally Invasive Full-Endoscopic Decompression for Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-11 07:38:21","doi":"10.21203/rs.3.rs-8066216/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c20ddd80-8292-4000-8e62-1d65994b6421","owner":[],"postedDate":"November 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-12T22:08:10+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-11 07:38:21","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8066216","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8066216","identity":"rs-8066216","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}