Comparative Effects and Safety of Full-Endoscopic Versus Microscopic Spinal Decompression for Lumbar Spinal Stenosis: A Meta-Analysis and Statistical Power Analysis of 6 Randomized Controlled Trials.

Abstract

This meta-analysis with statistical power analysis aimed to evaluate the difference between full-endoscopic and microscopic spinal decompression in treating spinal stenosis. We searched PubMed, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and CNKI (China National Knowledge Infrastructure) for relevant randomized controlled trials (RCTs) regarding the comparison of full-endoscopic versus microscopic spinal decompression in treating lumbar spinal stenosis through February 28, 2022. Two independent investigators selected studies, extracted information, and appraised methodological quality. Meta-analysis was conducted using RevMan 5.4 and STATA 14.0, and statistical power analysis was performed using G*Power 3.1. Six RCTs involving 646 patients met selection criteria. Meta-analysis suggested that, compared with microscopic decompression, full-endoscopic spinal decompression achieved more leg pain improvement (mean difference [MD], -0.20; 95% confidence interval [CI], -0.30 to -0.10; p = 0.001), shortened operative time (MD, -12.71; 95% CI, -18.27 to -7.15; p < 0.001), and decreased the incidence of complications (risk ratio, 0.43; 95% CI, 0.22-0.82; p = 0.01), which was supported by a statistical power of 98.57%, 99.97%, and 81.88%, respectively. Full-endoscopic spinal decompression is a better treatment for lumbar spinal stenosis, showing more effective leg pain improvement, shorter operative time, and fewer complications than microscopic decompression.